EMPLOYMENT OF THE
TACTICS, TECHNIQUES, AND PROCEDURES
HEADQUARTERS, DEPARTMENT OF THE ARMY
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HOSPITALIZATION SYSTEM IN A THEATER OF OPERATIONS
1-1. Combat Health Support in a Theater the theater evacuation policy are evacuated to a
of Operations corps and/or COMMZ hospital. Those patients
classified as NRTD follow the evacuation chain
a. A theater of operations (TO) is that for trauma care and stabilization for evacuation
portion of an area of war necessary for military out of the theater.
operations and for the administration of such
operations. The scenario depicts the size of the
TO and the US Forces to be deployed. The theater 1-2. Echelons of Combat Health Support
is normally divided into a combat zone (CZ) and
a communications zone (COMMZ). In some The CHS system within a TO is organized into
instances, the COMMZ may be outside the TO four echelons of support which extend rearward
and located in offshore support facilities, Third throughout the theater (see Figure l-l). The
Country support bases, or in the continental system is tailored and phased to enhance patient
United States (CONUS). The CZ begins at the identification, evacuation, treatment, and RTD as
Army/corps rear boundary and extends forward far forward as the tactical situation will permit.
to the extent of the commander’s area of Hospital resources will be employed on an area
influence. The COMMZ begins at the corps rear basis to provide the utmost benefit to the
boundary and extends rearward to include the maximum number of personnel in the area of
area(s) needed to provide support to the forces in operations (AO). Each echelon reflects an
the CZ. increase in capability, with the function of each
lower echelon being contained within the
b. The mission of the AMEDD is to capabilities of the higher echelon. Wounded, sick,
conserve the fighting strength. This mission of or injured soldiers will normally be treated,
CHS is a continuous and an integrated function returned to duty, and/or evacuated to CONUS
throughout the TO. It extends from the CZ back (Echelon V) through these four echelons:
through the COMMZ and ends in CONUS.
Combat health support maximizes the system’s a. Echelon 1. This echelon is also
ability to maintain presence with the supported known as unit level. Care is provided by desig-
soldier, return injured, sick, and wounded soldiers nated individuals or elements organic to combat
to duty, and to clear the battlefield of soldiers and combat support (CS) units and elements of
who cannot return to duty (RTD). Patients are the area support medical battalion (ASMB).
examined, treated, and identified as RTD or Major emphasis is placed on those measures
nonreturn to duty (NRTD) as far forward as is necessary to stabilize the patient (maintain
medically possible. Early identification is per- airway, stop bleeding, prevent shock) and allow
formed by the treating primary care provider and for evacuation to the next echelon of care.
continues in the evacuation chain with constant
reassessment. Patients requiring evacuation out (1) Combat medic. This is the first
of the division who are expected to RTD within individual in the CHS chain who makes medically
substantiated decisions based on medical military evacuation to the next echelon of care. Each
occupational specialty (MOS)-specific training. squad can split into two trauma treatment teams.
The combat medic is supported by first-aid These squads are organic to medical platoons/
providers in the form of self-aid and buddy aid sections in maneuver battalions and designated
and the combat lifesaver. CS units and medical companies of separate
brigades, divisions, and echelons above division
(a) Self-aid and buddy aid. in the ASMB. Treatment squads (treatment
The individual soldier is trained to be proficient teams) may be employed anywhere on the
in a variety of specific first-aid procedures with battlefield. When not engaged in ATM, these
particular emphasis on lifesaving tasks. This elements provide routine sick call services on an
training enables the soldier, or a buddy, to apply area basis. Echelon I care for units not having
immediate care to alleviate a life-threatening organic Echelon I capability is provided on an
situation. area basis by the organization responsible in the
(b) Combat lifesaver. En- b. Echelon II. This echelon may also
hanced medical training is provided to selected be known as division level. Care at this echelon
individuals who are called combat lifesavers. is rendered at the clearing station (division or
These individuals are nonmedical unit members corps). Here the casualty is examined and his
selected by their commander for additional wounds and general status are evaluated to
training to be proficient in a variety of first-aid determine his treatment and evacuation
procedures. A minimum of one individual per precedences, as a single casualty among other
squad, crew, team, or equivalent-sized unit is casualties. Those patients who can RTD within 1
trained. All combat units and some CS and to 3 days are held for treatment. Emergency
combat service support (CSS) units have combat medical treatment (EMT) (including beginning
lifesavers. The primary duty of these individuals resuscitation) is continued and, if necessary,
does not change. The additional duties of combat additional emergency measures are instituted;
lifesavers are performed when the tactical but they do not go beyond the measures dictated
situation permits. These individuals provide by the immediate necessities. The division
enhanced first-aid care for injuries prior to clearing station has blood replacement capability,
treatment by the combat medic. The training is limited x-ray and ambulatory services, patient
normally provided by medical personnel assigned holding capability, and emergency dental care.
or attached to the unit. The training program is Clearing stations provide Echelon I CHS
managed by a senior medical person designated functions on an area basis to those units without
by the commander. organic medical elements. Echelon II CHS also
includes preventive medicine (PVNTMED)
(2) Treatment squad. The treat- activities and combat stress control (CSC). These
ment squad consists of a field surgeon, a functions are performed typically by company-
physician assistant (PA), two noncommissioned sized medical units organic to brigades, divisions,
officers (NCOs), and four medical specialists. and ASMBs.
The personnel are trained and equipped to
provide advanced trauma management (ATM) c. Echelon III. The first hospital
to the battlefield casualty. Advanced trauma facilities are located at this echelon. Within the
management is emergency care designed to CZ, the mobile army surgical hospital (MASH)
resuscitate and stabilize the patient for and the CSH are staffed and equipped to provide
resuscitation, initial wound surgery, and post- on the Medical Force 2000 hospital system, refer
operative treatment. Although the MASH is to FM 8-10.
an Echelon III facility, it is designed to be
employed within the division area. At the CSH, (1) Mobile army surgical hospital.
patients are stabilized for continued evacuation, This hospital is a 30-bed facility with the primary
or returned to duty. Those patients who are mission of providing lifesaving surgical and
expected to RTD within the theater evacuation medical care to stabilize patients for further
policy are regulated to a facility that has the evacuation, either to the CSH or to COMMZ
capability for reconditioning and rehabilitating. hospitals. Patients are held approximately 24 to
36 hours until considered stable enough to
d. Echelon IV. At this echelon, the tolerate a bed-to-bed transfer without incurring
patient may be treated at the general hospital further risk to their condition. The MASH will
(GH) or the field hospital (FH). The GHs are be employed in the corps area or forward in the
staffed and equipped for general and specialized division rear area. This hospital is not Deployable
medical and surgical care. Those patients not Medical Systems (DEPMEDS)-equipped. It is 100
expected to RTD within the theater evacuation percent mobile with organic vehicles.
policy are stabilized and evacuated to CONUS.
At the FH, reconditioning and rehabilitating (2) Forward surgical team. A
services are provided for those patients who will forward surgical team (FST) will replace the two
be RTD within the theater evacuation policy. surgical squads in each of the following: the
airborne division; the air assault division; and the
2d Armored Cavalry Regiment (ACR). The FSTs
e. Echelon V. This echelon of care is will also replace the medical detachment
provided in CONUS. Hospitalization is provided (surgical) and the 30-bed MASH. This team will
by DOD hospitals (military hospitals of the be a corps augmentation for divisional and
triservices) and Department of Veterans Affairs nondivisional medical companies. It will provide
(DVA) hospitals. Under the National Disaster emergency/urgent initial surgery and nursing
Medical System, patients overflowing DOD and care after surgery for the critically wounded/
DVA hospitals will be cared for in designated injured patient until sufficiently stable for
civilian hospitals. evacuation to a theater hospital. The FSTs not
organic to divisions and the 2d ACR will be
assigned to a medical brigade or group and
normally attached to a corps hospital when not
1-3. Theater Hospital System operationally employed and further attached
for support to a divisional/nondivisional medical
a. Medical Force 2000 is the modern- company.
ization effort to restructure the CHS system
including hospitalization in support of a TO. This (3) Combat support hospital. This
system consists of four hospitals, a medical hospital is addressed in detail in the following
company, holding, and six medical/surgical teams. chapters of this publication.
The two corps hospitals are the MASH and the
CSH. The two COMMZ hospitals are the FH and (4) Field hospital. This hospital is
the GH. In addition to these hospitals, the a 504-bed facility with the mission of providing
medical company, holding, provides a 1,200-cot hospitalization for patients and for reconditioning
convalescent capability. For a detailed discussion and rehabilitating those patients who can RTD
within the theater evacuation policy. The 3-week CSC reconditioning program. This unit
majority of patients within this facility will be in is staffed and equipped to provide care for
the convalescent care category. The FH is minimal category (self-care) patients.
normally located in the COMMZ, but could be
used in the corps rear when geographical b. The CSH, FH, and GH are designed
operational constraints dictate. It is 20 percent using the following four modules:
mobile with organic vehicles.
(1) Hospital unit, base (HUB).
(5) General hospital. This organi-
zation is a 476-bed facility with the mission of
providing stabilization and hospitalization for (2) Hospital unit, surgical (HUS).
patients who require either further evacuation
out of the TO, or who can RTD within the theater (3) Hospital unit, medical (HUM).
evacuation policy. The GH will normally be
located in the COMMZ. Its mobility is 10 percent (4) Hospital unit, holding (HUH).
with organic vehicles.
They are configured using the appropriate com-
(6) Medical company, holding. bination of these modules. The HUB can operate
This unit provides reconditioning and rehabili- independently, is clinically similar, and is located
tation for up to 1,200 convalescent care patients. in each hospital as the initial building block. The
This unit may be located in the corps or COMMZ. other three mission-adaptive modules (HUS,
It is used to augment the CSH when operational HUM, and HUH) are dependent upon the HUB
necessity dictates. It may also be used in the (see Figure 1-2, page 1-6.
THE COMBAT SUPPORT HOSPITAL
2-1. Mission and Allocation • Pharmacy, clinical laboratory,
blood banking, radiology, physical therapy, and
The mission of this hospital is to provide nutrition care services.
resuscitation, initial wound surgery, post-
operative treatment, and RTD those soldiers in • Medical administrative and
the CZ who fall within the corps evacuation logistical services to support work loads.
policy, or to stabilize patients for further evacua-
tion. This hospital is capable of handling all types • Dental treatment to staff and
of patients. It has a basis of allocation of 2.4 patients and oral and maxillofacial surgery sup-
hospitals per division. port for military personnel in the immediate area
plus patients referred by the area CHS units.
2-2. Assignment and Capabilities 2-3. Hospital Support Requirements
a. The CSH is assigned to the Head- In deployment and sustainment of operations,
quarters and Headquarters Company (HHC), this unit is dependent upon appropriate elements
Medical Brigade, TOE 08-422L100. The hospital of the corps for—
may be further attached to the Headquarters
and Headquarters Detachment (HHD), Medical • Personnel administrative services.
Group, TOE 08-432L000.
b. This unit provides hospitalization
for up to 296 patients. The hospital has eight • Mortuary affairs and legal services.
wards providing intensive nursing care for up to
96 patients, seven wards providing intermediate • Transportation services (unit is 35
nursing care for up to 140 patients, one ward percent mobile with organic assets).
providing neuropsychiatric (NP) care for up to 20
patients, and two wards providing minimal • Laundry services for other than
nursing care for up to 40 patients. patient-related linen.
c. Surgical capacity is based on eight • Security and enemy prisoner of war
operating room (OR) tables for a surgical capacity (EPW) security during processing and evacu-
of 144 OR table hours per day. ation.
• Transportation for discharged pa-
d. Other capabilities include— tients.
• Consultation services for • Class I supplies (rations) to include
patients referred from other medical treatment the Medical B Rations required for patient feed-
facilities (MTFs). ing.
• Unit-level CHS for organic • Engineer support for site prepara-
personnel only. tion, waste disposal, and minor construction.
• Veterinary support for zoonotic 2-4. Hospital Organization and Func-
disease control and investigation; inspection of tions
medical and nonmedical rations, to include
suspected contaminated rations and disposition The CSH is a modular-designed facility which
recommendations; and animal bites. consists of a HUB and HUS. It can be further
augmented with specialty surgical/medical teams
• PVNTMED support for food facility to increase its capabilities. It may become a
inspection, vector control, and control of medical designated specialty center as the work load or
and nonmedical waste. mission dictates (Figure 2-1).
a. The HUB is a 236-bed facility which
has 36 intensive, 140 intermediate, 40 minimal,
and 20 NP care beds. It has two OR modules, one
surgical and the other orthopedic, which are
staffed to provide a total of 72 OR table hours per
day. It also allows for attachment of specialty
surgical teams. The HUB is an independent
organization which includes all hospital services
b. The HUS is comprised of 60 intensive
care beds, two OR modules, one x-ray module,
one triage/preoperative/EMT module, and the
appropriate staffs (Figure 2-3, page 2-5). The (1) Hospital commander (60A00).
HUS is dependent on the HUB for food service, Command and control is the process through
maintenance, and administration. which the activities of the hospital are directed,
coordinated, and controlled to accomplish the
c. When the HUB and HUS are em- mission. This process begins and ends with the
ployed to form a single hospital, half of the OR commander. An effective commander must have
tables are staffed for two 12-hour shifts with the a thorough knowledge and understanding of
other half only staffed for one 12-hour shift per planning and implementing CHS (FM 8-55). He
day. is decisive and provides specific guidance to his
staff in the execution of the mission. The success-
ful commander delegates authority and fosters
an organizational climate of mutual trust, co-
2-5. The Hospital Unit, Base operation, and teamwork. He has the overall
responsibility for coordination of CHS within the
The HUB provides a solid infrastructure for the hospital’s AO. Additionally, he is responsible for
CSH operations. The HUB contains the following the structural layout of the hospital.
(2) Chief, surgical service (61J00).
a. Hospital Headquarters Section. The chief surgeon is the principal advisor to the
This section provides internal command and hospital commander for surgical activities. He
control (C2) and management of all hospital provides supervision and control over the surgi-
services. Personnel of this section supervise and cal services to include the ORs. He prescribes
coordinate the surgical, nursing, medical, courses of treatment and surgery for patients
pastoral, and administrative services. Stafflng having injuries or disorders with surgical condi-
includes the HUB commander, the chiefs of tions and participates in surgical procedures as
surgery, nursing, and medicine, an executive required. He coordinates and is responsible for
officer (XO), a chaplain, a command sergeant all matters pertaining to the evaluation, manage-
major (CSM), and an administrative specialist ment, and disposition of patients received by the
(Table 2-1). When the HUB and the HUS join section. He is responsible for the evaluation and
to function as a CSH, the HUB commander is training programs for his professional staff. He
the CSH commander unless otherwise desig- also functions as the Deputy Commander for
nated. Professional Services.
(3) Chief nurse (66A00). The chief medical illnesses. He controls the length of patient
nurse is the principal advisor to the hospital stay through continuous patient evaluation, early
commander for nursing activities. This officer determination of disposition, or evacuation to the
plans, organizes, supervises, and directs nursing next echelon of care.
care practices and activities of the hospital. This
officer is also responsible for the orientation and (5) Executive officer (67A00). The
professional development programs for the hospital XO advises the commander on matters
nursing staff. pertaining to health care delivery. He plans,
directs, and coordinates administrative activities
(4) Chief, medicine services for the hospital. He provides guidance to the
(61F00). This officer is responsible for the exami- tactical operations center (TOC) staff in planning
nation, diagnoses, and treatment, or recom- for future operations. He also functions as the
mended course of management for patients with Chief, Administrative Service.
(6) Hospital chaplain (56A00).
The chaplain functions as the staff officer for all
matters in which religion impacts on command
programs, personnel, policy, and procedures. He
provides for the spiritual well-being and morale
of patients and hospital personnel. He also pro-
vides religious services and pastoral counseling
to soldiers in the AO.
(7) Command sergeant major
(00Z50). The CSM is the principal enlisted
representative to the commander. He advises the
commander and staff on all matters pertaining to
welfare and morale of enlisted personnel in terms
of assignment, reassignment, promotion, and
discipline. He provides counsel and guidance to
NCOs and other enlisted personnel of the
hospital. He is also responsible for the reception
of newly assigned enlisted personnel into the
unit. The CSM evaluates the implementation of
individual soldier training on common soldier
tasks and supervises the hospital’s NCO pro- (1) Medical operations officer
fessional development. (70H67). This officer is responsible to the XO for
(8) Administrative specialist the Intelligence Officer/Operations and Training
(71L20). The administrative specialist performs Officer (S2/S3) functions of the hospital. He
typing, clerical, and administrative duties for the supervises all tactical operations conducted by
hospital headquarters. He proofreads corre- the hospital to include planning and relocation.
spondence for proper spelling, grammar, punc- He is responsible for the formulation of the tacti-
tuation, format, and content accuracy. He cal standing operating procedures (TSOP) and
establishes and maintains files, logs, and other hospital planning factors (refer to Appendix A for
statistical information for the command. He is an example of a TSOP format and Appendix B for
the light-vehicle driver and radio operator for the an estimate of hospital planning factors).
(2) Field Medical Assistant
b. Hospital Operations Section. This (70B67). This officer is responsible to the medical
section is responsible for communications (in- operations officer for planning and coordinating
ternal and external), security, plans and opera- site selection and convoy operations during
tions, deployment, and relocation of the hospital. hospital deployment and relocation. He also
The staff is composed of a medical operations functions as the operations security (OPSEC) and
officer, a field medical assistant, an operations communications security (COMSEC) officer for
NCO, a nuclear, biological, and chemical (NBC) the hospital. The requirement for this position is
NCO, an administrative specialist, and appro- counted in the unit headquarters section (HUS).
priate communications personnel (Table 2-2). When the HUB and HUS form a CSH, the field
The authorization for the field medical assistant medical assistant, HUS becomes the field medical
is counted in the HUS. assistant in this section.
(3) Operations sergeant (91B40). the section chief for installation and operation of
The operations sergeant is responsible to the unit wire systems, associated equipment, and
medical operations officer for physical security, frequency modulated (FM) radios.
to include the hospital defense plan; preparation
of unit plans, operation orders (OPORDs) and (9) Administrative specialist (7L10).
map overlays; and intelligence information and This individual is responsible to the operations
records. He also supervises subordinate staff. sergeant for general typing and administrative
functions for the section.
(4) Section chief (31U40). This
NCO serves as the principal signal advisor to the (10) Signal support systems special-
hospital commander and medical operations offi- ist (31UI0). This individual is responsible to the
cer on all communications matters. He is respon- section chief for installing wire for field tele-
sible to the medical operation and plans officers phones and assisting in the operation of the hos-
for the planning, supervising, coordinating, and pital FM radios.
technical assistance in the installation, operation,
management, and operator-level maintenance of c. Company Headquarters. This sec-
radio, field wire, and switchboard communica- tion is responsible for company-level command,
tions systems. He supervises all subordinate duty rosters, weapons control, and mandatory
communications personnel. training. Staffing includes the company head-
quarters commander, the first sergeant, a decon-
(5) Nuclear, biological, and chem- tamination specialist, an administrative clerk,
ical noncommissioned officer (54B40). This NCO and an armorer (Table 2-3).
is the technical advisor to the hospital command-
er and medical operations officer on matters per-
taining to NBC operations. He is responsible to
the medical operations officer for the planning,
training, NBC decontamination (less patient),
and other aspects of hospital NBC defensive op-
(6) Electronic switch systems op-
erator (31F20). This operator is responsible to
the section chief for the installation, operation,
and operator-level maintenance of switchboards
and switching systems. (1) Company commander (70B67).
The company commander is responsible to the
(7) Electronic switch systems op- XO for all activities in the company headquarters.
erator (31FI0). These operators are responsible He administers Uniform Code of Military Justice
to the section chief for the installation, opera- (UCMJ) actions for enlisted personnel; plans and
tion, and unit-level maintenance on switchboards, conducts common task training; and functions as
switching assemblages, and associated communi- the commander of the medical holding detach-
cations equipment. ment, when assigned. When the HUB and HUS
are employed to form the CSH, the medical hold-
(8) Signal information service spe- ing detachment is assigned as dictated by the
cialist (31UIO). This individual is responsible to medical mission.
(2) First sergeant (91B5M). The
first sergeant is responsible to the company com-
mander for enlisted matters. He also assists in
supervising company administration and training
activities. He provides guidance to the enlisted
members of the company and represents them to
the company commander. He also functions as
the reenlistment NCO.
(3) Decontamination specialist
(54B10). This specialist is responsible to the first
sergeant for training the company’s NBC teams
on the operation of NBC detection and decontami-
nation equipment and for the operator main- (1) Hospital adjutant (70F67).
tenance on this equipment. He assists the NBC This officer is responsible to the hospital XO for
NCO in the establishment, administration, train- the adjutant functions within the hospital. He
ing, and application of NBC defense measures. also advises the commander and staff in the area
He also performs NBC reconnaissance and is of personnel management for patients and staff.
designated as a light-vehicle operator.
(2) Personnel sergeant (75240).
(4) Administrative clerk (71LI0). The personnel sergeant is responsible to the
The clerk-typist is responsible to the first adjutant for specific personnel functions which
sergeant for providing the personnel and unit include personnel management, records, actions,
administration support for the company head- and preparation of Standard Installation/Division
quarters. His duties consist of general admin- Personnel System (SIDPERS) changes. He en-
istration and personnel actions. sures coordination between the medical brigade
and/or medical group Personnel and Adminis-
(5) Armorer (92YI0). The armor- tration Center (PAC) and the hospital. He
er’s primary duty is that of maintaining the wea- advises the hospital commander, adjutant, and
pons storage area, small arms, and ammunition other staff members on personnel administrative
and performing small arms unit maintenance. matters. He also supervises the activities of
He is designated as the light-vehicle operator for subordinate personnel.
(3) Personnel administrative ser-
d. Administrative Division. This divi- geant (75B20). This individual is responsible to
sion provides overall administrative services for the personnel sergeant for personnel and admin-
the hospital to include personnel administration, istrative functions for the hospital.
mail distribution, awards and decorations, leaves,
and typing support. The staff is composed of the (4) Administrative specialists
hospital adjutant, personnel sergeant, personnel (71L10). These specialists are responsible to the
administrative sergeant, an administrative spe- personnel sergeant for general typing and admin-
cialist, mail delivery clerks, and an administra- istrative functions for the division.
tive clerk (Table 2-4). This section coordinates with
elements of corps support command (COSCOM) (5) Mail delivery clerks (71L10).
for finance, personnel, and administrative services. These administrative specialists are responsible
to the personnel staff NCO for establishing and (3) Patient administration non-
operating the unit mail room. They also assist commissioned officer (71G30). This NCO is re-
the personnel staff NCO with personnel and sponsible to the patient administration officer for
clerical duties. They are the designated light- patient administration and disposition proce-
vehicle operators for the division. dures, inpatient records, and security of patients’
personal effects. He works in concert with the
e. Patient Administration Division supply sergeant (company headquarters) on re-
(PAD). This division is responsible for the admis- equipping the RTD soldier. He also supervises
sion and disposition of patients, maintenance of the application of the Theater Army Medical
patient records, security of patient valuables, and Management Information System (TAMMIS) for
preparation of patient statistical reports for the the Medical Patient Accounting and Reporting
hospital. The staff is composed of the patient (MEDPAR) System and for the Medical Regula-
administration officers, NCOs, and specialists ting (MEDREG) System.
(1) Patient administration non-
commissioned officers (71G20). These NCOs are
responsible to the principal patient administra-
tion NCO for implementing the TAMMIS for the
hospital. They process correspondence received
for medical information. They also assist in
supervising subordinate specialists.
(5) Patient administration special-
ists (7IG10). These specialists are responsible to
the patient administration NCOs for preparing,
consolidating, and maintaining medical records
and statistics pertaining to patient data. They
also implement the TAMMIS for the division.
(1) Patient administration officer
(70E67). As chief of the PAD, this officer is re- f. Nutrition Care Division. This divi-
sponsible to the hospital XO for planning, orga- sion is responsible for providing hospital nutrition
nizing, directing, and controlling the patient ad- services, meal preparation and distribution to
ministration aspects of the hospital. He advises patients and staff; dietetic planning; and super-
the commander on patient administration matters. vision and control of overall operations. Hospital
He maintains close liaison with the chiefs of staff will be fed in accordance with the theater
services, attending physicians, and chiefs of ad- ration policy. The field medical feeding standard
ministrative sections and offices to ensure timely for hospitals is to prepare three hot meals per
decisions on patient administration matters. day plus nourishments and forced fluids using
Medical B (or A) Rations. Meals, ready to eat
(2) Patient administration officer (MRE) are not authorized for patient use.
(70E67). This officer assists the chief, PAD in Rations will be obtained from the supporting
developing plans and procedures for patient ad- COSCOM. Patient meals, nourishments, and
ministration support, to include patient statistical forced fluids will be distributed to the wards three
reports and medical regulation of patient disposi- times per day; tube feedings are provided inter-
tions (refer to FM 8-10-6). mittently as patient’s nutritional needs require.
(Refer to FM 8-505, Technical Manual [TM] 8- (5) Hospital food service sergeants
500, and Appendix B of this manual.) The staff (91M20). These sergeants are responsible to the
is composed of dietitians, hospital food service principal NCO and assist with the clinical and
NCO, and hospital food service specialists (Table administrative management of nutritional care
(6) Hospital food service special-
ists (91M10). These hospital food service special-
ists are responsible to the hospital food service
sergeants for performing basic clinical dietetic
functions in the dietary management and treat-
ment of patients. They prepare, cook, and serve
regular and modified food. They also perform
light-vehicle operator/driver duties for the divi-
sion, to include operator maintenance.
g. Supply and Service Division. This
division provides logistics functions throughout
the hospital, to include laundry, general and
(1) Chief nutrition care division medical supplies, and maintenance; blood man-
(65C00). This officer is responsible to the Chief, agement (see Appendix B [paragraph B-4 k ]);
Administrative Services for the operation of this utilities such as water distribution, waste dis-
division. He directs and supervises the operation posal, and environmental control of patient treat-
of nutrition care services. ment areas; power and vehicle maintenance;
equipment records and repair parts; fuel distri-
(2) Dietitian (65C00). This officer bution; and transportation to include ground/air
is responsible to the Chief, Nutrition Care for movement operations. The logistics division re-
formulating policies, developing procedures, and quests resupply from the supporting medical
assisting in supervising the operation of nutrition logistics (MEDLOG) battalion (forward) and
care. This officer also assists physicians in COSCOM elements using whatever communica-
dietary management of patients. tion links are available and compatible with the
Theater Army Medical Management Information
(3) Hospital food service noncom- System-Medical Logistics (TAMMIS-MEDLOG).
missioned officer (91M40). This NCO serves as Medical logistics and medical maintenance
the principal NCO for the nutrition care division. (MEDMNT) will be managed utilizing TAMMIS-
He is responsible to the Chief, Nutrition Care for MEDLOG and TAMMIS-MEDMNT. This divi-
the implementation of policies and procedures sion coordinates with COSCOM elements for
and for supervision of subordinate personnel. materiels handling equipment (MHE) capable of
moving DEPMEDS equipment, environmental
(4) Hospital food service noncom- control units, and power distribution equipment
missioned officer (91M30). This NCO is respon- for the hospital. This division is also responsible
sible to and serves as an assistant to the principal for maintaining the unit property book and for
NCO in nutrition care operations. He imple- establishing a temporary morgue for handling
ments and directs contingency and combat feed- remains until transported to supporting mortuary
ing plans. affairs organization. This section coordinates
with elements of the corps and COSCOMs for will also coordinate with the COSCOM for the
movement control, nonmedical supplies and transportation of these soldiers to the replace-
equipment, and field services. This section will ment companies. Table 2-7 lists the staffing for
provide one basic uniform to RTD soldiers and this division.
(l) Health service materiel officer division, to include medical supply operations,
(70K67). This officer irresponsible to the Chief, stock control, and medical assemblage manage-
Administrative Services. He plans, coordinates, ment. He is responsible for the development and
and manages the entire logistics system for the preparation of plans, maps, overlays, sketches,
hospital. Additionally, he controls and manages arid other administrative procedures related to
the budget for the hospital commander. He is employment of the supply and service division.
also responsible for hospital field waste and safety
procedures (refer to Appendixes C and D for (6) Motor sergeant (63B40). This
examples of these programs). NCO is responsible to the power systems techni-
cian for unit maintenance on wheeled vehicles
(2) Health service materiel officer and MHE and the upkeep of hand and power
(70K67). This officer is responsible to the Chief, tools. He supervises, trains, advises, and inspects
Supply and Services Division. He has primary subordinate personnel in the use of the Army
responsibility for the medical supply area and Maintenance Management System (TAMMS),
functions as the supply officer for the hospital. prescribed load list (PLL), and automated sys-
This officer is also responsible for managing the tems output. He is also responsible for super-
controlled substances stored by the medical sup- vising the training and licensing of vehicle and
ply section. equipment operators and ensuring their skills
(3) Power systems technician
(210A5). This warrant officer is responsible to (7) Medical equipment repairer/
the Chief, Supply and Services Division. He supervisor (91A30). This NCO is responsible to
advises the command on the status, maintenance, the health service maintenance technician for
and repairs of general support (GS) equipment. performing and supervising hospital medical
He supervises organizational maintenance of maintenance operations. He is responsible for
wheeled vehicles, associated support equipment, interpreting technical publications that apply to
and power support equipment. He is responsible inspection, troubleshooting, maintenance, repair,
for the preparation of log books, maintenance calibration, and testing of medical equipment.
records, and associated reports. He also supervises the operation of TAMMIS-
(4) Health service maintenance
technician (670A0). This warrant officer is re- (8) Senior utilities equipment re-
sponsible to the Chief, Supply and Services Divi- pairer (52C30). This NCO is responsible to the
sion. He supervises and assists in the installation power systems technician for supervising and
and maintenance of hospital equipment. He performing unit maintenance of utilities quarter-
serves as the technical consultant to all members master equipment. He inspects the installation
of the hospital staff on medical maintenance mat- and condition of power generation and distri-
ters. He also supervises scheduled (preventive bution equipment systems.
maintenance) and unscheduled (repair) services
on medical and related equipment within his (9) Shower noncommissioned offi-
scope of responsibility. cer (57E30). This NCO is responsible to the
medical supply sergeant for the supervision of
(5) Medical supply noncommis- laundry and bath operations for the hospital. He
sioned officer (76J40). This NCO assists the supervises the subordinate laundry specialists.
division chief in the supervision of the logistics He coordinates with the supporting engineer unit
and quartermaster unit for water support and equipment. They are also light-vehicle operators
wastewater disposal. for the section.
(10) Senior mechanic (63B30). This (15) Power-generator equipment re-
NCO assists the motor sergeant in the perfor- pairer (52D20). This NCO is responsible to the
mance of his duties. He instructs and supervises power systems technician for performing unit-
subordinate personnel in proper unit mainte- level maintenance functions on power generation
nance practices and procedures. equipment and associated items. He also super-
vises the subordinate power-generator equipment
(11) Medical storage supervisor repairer.
(76J30). This NCO is responsible to the medical
supply sergeant for supervising and planning (16) Team chiefs (57E20). These
hospital storage activities. He operates the NCOs assist the shower NCO in performing his
TAMMIS-MEDLOG for the hospital. duties. They also conduct laundry site recon-
naissance to determine the best site based on
(12) Supply sergeant (92Y30). The drainage, water supply, hospital layout, cover,
supply sergeant is responsible to the medical and concealment.
supply NCO for the requisitioning, accountabili-
ty, and issuing of general supplies and equipment (17) Light-wheeled vehicle mechanic
for the hospital. He keeps the property book for (63B20). This mechanic iS responsible tO the
the hospital on the Tactical Army Combat Service motor sergeant for those mechanical duties with-
Support (CSS) Computer System (TACCS), using in his scope of responsibility. He also performs
the standard property book supply revised (SPBS- driver operator duties.
R} system. He works in concert with the PAD
and requests, from the supporting direct support (18) Quartermaster and chemical
(DS) supply company, those minimum Class II equipment repairer (63J20). This NCO is respon-
supply items authorized for issue to RTD soldiers sible to the senior utilities equipment repairer for
(to include mission-oriented protective posture troubleshooting and repairing quartermaster and
[MOPPI gear, if required). He ensures that RTD chemical equipment malfunctions.
soldiers are provided transportation to the re-
placement company. The supply sergeant super- (19) Medical supply sergeants (76J20).
vises the activities of the supply specialists. These NCOs are responsible to the medical sup-
ply NCO in performing medical supply duties.
(13) Medical equipment repairer They supervise the medical supply specialists.
(91A20). This NCO assists the medical equip-
ment repairer/supervisor in the performance of (20) Equipment receiver/parts spe-
his duties. He advises and assists equipment cialist (92A20). This soldier is responsible to the
operators in the assembly and disassembly of field motor sergeant for maintaining equipment rec-
medical equipment. ords and repair parts list and performing mainte-
nance control duties. He also performs driver
(14) Utilities equipment repairers operator duties.
(52C20). These NCOs are responsible to the
senior utilities equipment repairer for repair and (21) Signal support systems main-
maintenance of utilities-type equipment. They in- tainer (31U10). This individual is responsible to
stall heating, refrigeration, and air-conditioning the medical supply sergeant for removing,
installing, and providing unit-level maintenance (28) Medical supply specialists
of tactical radio communications systems, field (76J10). These specialists are responsible to the
wire equipment, and other electronic items of medical supply sergeants for performing desig-
equipment. He works in coordination with the nated medical supply and equipment functions.
Chief, Hospital Operations Section. They are designated light-vehicle operators for
(22) Medical equipment repairers
(91A10). These repairers are responsible to the (29) Petroleum light-vehicle opera-
medical equipment repairer/supervisor for per- tors (77F10). These petroleum light-vehicle op-
forming unit-level maintenance on assigned erators are responsible to the motor sergeant.
medical equipment. They also assist in training They receive, store, account and care for, dis-
equipment operators in the performance of pense, issue, and ship bulk and packaged
operator-level preventive maintenance checks petroleum, oil, and lubricant (POL) supplies.
and services (PMCS). They also operate and maintain the petroleum
(23) Utilities equipment repairers
(52C10). These repairers are responsible to the (30) Supply specialists (92Y10).
senior equipment repairer for unit maintenance These supply specialists assist the supply ser-
of refrigeration equipment, air-conditioning units, geant in the accomplishment of his duties.
and gasoline engines used as prime movers of
refrigeration units. They are also vehicle opera-
tors for their section. (31) Quartermaster and chemical
equipment repairer (63J10). This equipment
(24) Power generator equipment re- repairer is responsible to the quartermaster and
pairers (52D10). These equipment repairers are chemical equipment repairer NCO for unit main-
responsible to the power generator equipment tenance on quartermaster and chemical equip-
repairer NCO for operator and unit maintenance ment.
of tactical utility and power generation equip-
ment and associated items. (32) Equipment receiver/parts spe-
cialist (92A10). This specialist is responsible to
(25) Laundry specialists (57E10). the motor sergeant for maintaining equipment
These specialists are responsible to the shower records and repair parts lists and performing
NCO for performing their designated duties. maintenance control duties.
(26) Light-wheeled vehicle mechanics h. Nursing Service Control Team. This
(63B10). These specialists are responsible to the team is responsible to the Chief, Nursing Service
light-wheeled vehicle mechanic NCO for perform- for supervision of all nursing service personnel
ing their designated duties. They are vehicle regardless of organizational placement. This
operators for the division. team also provides daily patient reports to the
chief nurse and PAD and is responsible for the
(27) Recovery vehicle operator standards of nursing practice and nursing care
(63B10). This specialist is responsible to the throughout the facility. The staff to provide this
senior mechanic for unit-level maintenance and control are the assistant chief nurse, chief and
recovery operations on light- and heavy-wheeled assistant chief wardmasters, and a respiratory
vehicles, MHE, and associated items. NCO (Table 2-8).
hospital The staff will be trained in both ad-
vanced cardiac life support (ACLS) and ATM.
The staff monitors patient conditions and pre-
pares those requiring immediate surgery for the
OR. Sick call for organic staff is conducted by
this section. Table 2-9 lists the staffing for this
(1) Assistant chief nurse (66A00).
The assistant chief nurse works in concert with
the Chief, Nursing Service. This nurse plans,
organizes, executes, and directs nursing care
practices for the hospital. This officer holds the
additional skill identifier (ASI) 8J as an infection
(2) Chief wardmaster (91C50).
This master sergeant manages and supervises
enlisted personnel and assists in the planning
and operation of nursing service. He coordinates
with the operations section in planning the
hospital layout. He is responsible to the chief
nurse for the erection of the hospital clinical
(3) Assistant chief wardmaster (1) Emergency physician (62A00).
(91C40). This NCO assists the chief wardmaster This physician is responsible to the Chief,
in supervision of enlisted personnel and operation Professional Services (or the designated chief of
of nursing service. emergency medical services) for management and
operations of this section. He examines, diag-
(4) Respiratory noncommissioned noses, and treats or prescribes courses of treat-
officer (91V40). Under the technical guidance of ment for the initial phase of diseases and injuries.
a physician or nurse anesthetist, this NCO super- This officer is the physician primarily responsible
vises the respiratory activities within nursing for triage.
(2) Head nurse (66H00). This
i. Triage/Preoperative/Emergency Medi- nurse manages the operations of the EMT sec-
cal Treatment. This section provides for the tion, to include staffing and supervising nursing
receiving, triaging, and stabilizing of incoming personnel and developing nursing policies and
patients. The staff will receive patients, assess procedures. He is also responsible for the stan-
their medical condition, provide EMT, and dard of nursing care provided and assists in pro-
transfer them to the appropriate areas of the viding patient care.
(3) Primary care physician
(61H00). This physician provides care to patients
in the areas of general medicine, obstetrics/
gynecology (OB/GYN), psychiatry, PVNTMED,
pediatrics, and orthopedics. When the EMT/
surgical patient load is heavy, this officer can
assume the duties of triage and preoperative
(4) Emergency physician (62A00). (1) Senior litter bearers (91B20).
These NCOs are responsible to the emergency
This physician examines, diagnoses, and treats treatment NCO (triage/preoperative/EMT sec-
or prescribes course of treatment for the initial tion). They supervise and coordinate the acti-
phase of disease and injuries. vities of the subordinate litter bearers.
(5) Medical-surgical nurses (66H00). (2) Litter bearers (91B10). These
These nurses plan and implement nursing care litter bearers are responsible for transporting
under the supervision of the head nurse. They patients internally in the hospital. They are also
provide direct supervision to subordinate nursing responsible for loading and off-loading air and
service personnel. ground ambulances.
(6) Emergency treatment noncom- k. Operating Room/Central Materiel
missioned officer (91B40). This NCO is respon- Service (CMS) Control Team. This team provides
sible to the senior nurse. He manages and supervision of the OR and CMS. It is responsible
supervises the enlisted nursing staff. He is also for the scheduling of nursing staff, preparing and
responsible for supplies and equipment. maintaining the OR and CMS, and the main-
taining of surgical, anesthetic, and nursing stand-
(7) Emergency treatment non- ards within these areas. The OR/CMS control
commissioned officers (91B30/91B20). These team is composed of an anesthesiologist, a clinical
NCOs are supervised by the principal NCO. They head nurse, an OR NCO, and a CMS NCO (Table
perform direct patient care within their scope 2-11).
of practice and under professional supervision.
They supervise subordinate nursing staff.
(8) Medical specialists (91B10).
Under professional supervision, these specialists
are responsible for providing nursing care within
their scope of practice.
j. Litter Bearer Section. This section
is responsible to the triage/preoperative/EMT
section for the transportation of patients within
the hospital on a 24-hour basis. The staffing is
identified in Table 2-10.
(1) Anesthesiologist (60N00). This (1) General surgeon (61J00). The
physician supervises team members and is re- senior physician is responsible to the Chief, Sur-
sponsible to the Chief, Surgical Services. He gical Service for the operations of the surgery
establishes the hospital’s anesthesiology program. team. These physicians examine, diagnose, and
He administers or supervises administration of treat or prescribe courses of treatment and sur-
anesthetics to patients in the ORs. gery for patients having injuries or disorders with
(2) Operating room clinical head
nurse (66E00). This officer is responsible to the (2) Operating room nurse (66E00).
chief nurse for the management of daily opera- This nurse is responsible to the OR clinical head
tions of the OR and CMS to include scheduling nurse for all nursing activities of this section. He
and supervision of nursing staff. He coordinates supervises the OR enlisted staff. This officer
with the Chief, Surgical Services in the sched- performs nursing duties in any phase of the op-
uling of patient cases. He is responsible for the erative process for patients undergoing surgery;
quality of nursing care provided. he ensures that safe supplies and equipment are
available for operative services.
(3) Central materiel service non-
commissioned officer (91D40). This NCO is re- (3) Operating room nurse (66E00).
sponsible to the clinical head nurse for supplies, This nurse performs nursing duties in any phase
equipment maintenance, and supervision of en- of the operative process for patients undergoing
listed CMS nursing staff. surgery; he also ensures that safe supplies and
(4) Operating room noncommis- equipment are available for operative services.
sioned officer (91D40). This NCO is responsible He supervises the OR enlisted nursing staff. He
to the clinical head nurse for the supervision and is responsible to the chief OR nurse.
management of the enlisted OR nursing staff. He
also manages supplies and equipment. (4) Clinical nurse, anesthetists
(66F00). These two anesthetists perform nursing
l. Operating Room A. This section pro- duties of a specialized nature in the care of pa-
vides general surgical services with two OR tables tients requiring general or regional anesthesia,
for a total of 36 hours of table time per day. The respiratory care, cardiopulmonary resuscitation,
staff is composed of general surgeons, OR nurses, and/or fluid therapy. Under the supervision of
nurse anesthetists, and OR specialists (Table 2-12). the anesthesiologist (OR/CMS control team), they
administer general and regional anesthesia for
(5) Operating room noncommis-
sioned officer (91D30). This NCO is responsible
to the chief OR nurse for supplies, equipment
maintenance, and supervision of enlisted nursing
(6) Operating room specialists
(91D20/91D10). Under professional supervision,
these specialists provide patient care within their
scope of practice.
m. Operating Room B. This section
provides orthopedic surgical services with two OR
tables for a total of 36 hours of table time per day.
The staff is composed of orthopedic surgeons, OR
nurses, nurse anesthetists, OR NCO, and OR
specialists (Table 2-13). This OR may be used by
the oral surgeon in performing oral and maxillo-
(1) Orthopedic noncommissioned
officer (91B20, ASI P1). This NCO is responsible
to the senior orthopedic surgeon for the operation
of this clinic. He supervises the other specialists.
(2) Orthopedic specialists (91B10,
ASI P1). Under professional supervision, these
specialists provide patient care within their scope
o. Central Materiel Service. This sec-
tion operates two CMS units which provide steri-
lization of OR equipment, surgical instruments,
and supplies, as well as sterile supplies for other
(1) Orthopedic surgeons (61M00). patient care areas. The staff is composed of two
The senior physician is responsible to the Chief, CMS sergeants and six CMS specialists (Table
Surgical Service for operations of the OR. These 2-15).
physicians examine, diagnose, and treat or
prescribe courses of treatment and surgery
for patients having disorders, malfunctions,
diseases, and/or injuries of the musculoskeletal
(2) Remaining staff. The duties
and responsibilities of the remaining OR B staff
are the same as the corresponding staff identified
in paragraph l. The OR specialist (91D10) is the
designated vehicle operator for this section.
(1) Central materiel service spe-
n. Orthopedic Cast Clinic. This clinic cialists (91D20). These NCOs work under the
is responsible to the senior orthopedic surgeon supervision of the CMS NCO of the OR/CMS
for casting, splinting, and traction services for control team. They supervise the activities of the
the hospital. The staff is composed of an CMS specialists. They ensure that sterilization
orthopedic NCO and orthopedic specialists (Table techniques and procedures are applied and fur-
2-14). ther ensure that safe sterile supplies are provided
to users on a timely basis. They also supervise staff and in-patients. When work load permits,
operator-level maintenance on CMS equipment. this officer provides maintaining-level dental care
to the same population and to patients referred
(2) Central materiel service spe- from other dental and medical facilities when
cialists (91D10). These CMS specialists are re- the required dental treatment is beyond the ca-
sponsible to the CMS section sergeants. They pability of the referring facility. In addition, he
perform CMS functions within their scope of provides OR assistance and support to the oral
responsibility. and maxillofacial surgeon, when requested. He
also augments the ATM capability of the hospital,
P. Dental Services. This section pro- particularly during mass casualty situations.
vides dental services and consultation for patients
and staff. During mass casualty situations, the (3) Preventive dental noncommis-
dentists assist in the delivery of ATM. The oral sioned officer (91E20). This NCO assists the
surgeon uses the ORB or the dental operatory to dental officers in prevention, examination, and
perform oral and maxillofacial surgery. The staff treatment of diseases of teeth and oral region.
is composed of an oral surgeon, a comprehensive He also performs those administrative tasks as
dental officer, a preventive dental NCO, and a directed by the oral surgeon. He supervises
dental specialist (Table 2-16). operator-level maintenance of the dental equip-
ment. This NCO holds the ASI X2, designating
formal dental hygiene training.
(4) Dental specialist (91E10). This
specialist is responsible to the preventive dental
NCO. He assists in the prevention, examination,
and treatment of diseases of teeth and oral re-
gion. He performs operator-level maintenance of
q. Inpatient Medicine A. This section
provides medical services such as consultations,
as requested; evaluation and treatment of infec-
(1) Oral and maxillofacial surgeon tious disease and internal medicine disorders;
(63N00). This officer examines, diagnoses, and evaluation and treatment of skin disorders; and
treats or prescribes courses of treatment for con- treatment of patients with gynecological disease,
ditions which involve oral surgical procedures, injury, or disorders. Staffing includes internists,
including oral and maxillofacial injuries, wounds, primary care physicians, and an obstetrician and
and infections. Additionally, treatment is pro- gynecologist (Table 2-17).
vided to patients referred by other dental and
medical facilities when required oral and maxillo-
facial care is beyond the capability of the refer-
ring facility. This officer is responsible to the
Chief, Professional Services for the technical and
administrative management of the section.
(2) Comprehensive dental officer
(63B00). This officer provides emergency care to
(1) Obstetrician/gynecologist scheduling and supervision of nursing staff. They
(60J00). This physician provides medical care are responsible for the quality of nursing care.
during pregnancy, performs obstetric deliveries, They supervise all other ICU nursing personnel.
and examines, diagnoses, and treats or prescribes
courses of treatment for patients who have gyne-
cological disease, injury, or disorders. He is re-
sponsible to the Chief, Professional Services for
the technical and administrative management of
(2) Internists (61F00). These in-
ternists examine, diagnose, and treat patients
with medical illnesses and recommend courses of
management for those illnesses.
(3) Primary care physicians
(61H00). These physicians provide comprehen-
sive health care to patients in the areas of general
medicine, OB/GYN, psychiatry, PVNTMED, pe-
diatrics, and orthopedics in both inpatient and (2) Clinical nurses, intensive care
outpatient care. They may be used to augment unit (66H00). These clinical nurses are respon-
surgical specialties in triage and preoperative sible to the clinical head nurse for planning and
care. providing nursing care of a specialized and tech-
nical nature for the care and treatment of criti-
r. Intensive Care Unit Wards. These cally injured or ill and postanesthesia patients.
three 12-bed intensive care units (ICUs) provide They supervise enlisted nursing personnel.
for critically injured or ill patients. As ICU
nurses, the clinical nurses hold an ASI of 8A. (3) Wardmasters (91C40). These
This section is under the supervision of the nurs- NCOs work under the supervision of the ICU
ing service control team. Nursing care is per- head nurses. They also work in concert with the
formed for those patients who require close ob- chief wardmaster of the nursing control team.
servation and vital sign monitoring, complex They manage and supervise enlisted personnel
nursing care, and mechanical respiratory assis- and assist in the planning and operation of the
tance. The ICU is also used as a postanesthesia ICU.
recovery area for patients after surgery. Inten-
sive care is provided by a staff of a clinical head (4) Practical nurses (91C30).
nurse, clinical nurses, a wardmaster, practical These practical nurses are responsible to the
nurses, and medical and respiratory specialists wardmaster. They provide direct patient care
(Table 2-18). under professional supervision within their scope
of practice. They also assist in supervising the
(1) Clinical head nurses, intensive subordinate enlisted nursing staff.
care unit (66H00). These officers are responsible
to the nursing service control team for managing (5) Respiratory noncommissioned
the operations of the ICU to include the develop- officers (91V30). These NCOs provide technical
ment of nursing policies and procedures and the guidance and training of subordinate personnel.
They manage the respiratory care functions
under the supervision of a physician or nurse
(6) Practical nurses (91C20). These
practical nurses perform preventive, therapeutic,
and emergency nursing care procedures under
professional supervision within their scope of
(7) Respiratory sergeants (91V20).
These respiratory sergeants provide treatment
for patients with cardiopulmonary problems
under the supervision of a physician or nurse
anesthetist. Included is emergency care in cases
of heart failure, shock, treatment of acute t. Neuropsychiatric Ward and Consul-
respiratory symptoms in cases of head injuries, tation Service. This section provides NP diag-
and respiratory complications in patients having nosis and consultation to all areas of the hospital;
thoracic or abdominal surgery. it staffs a 20-bed ward for inpatient stabilization
of NP patients. The staff for this section consists
(8) Medical specialists (91B10). of a psychiatrist, psychiatric nurses, clinical
These specialists provide direct patient care nurses, a social worker, a behavioral science
within their scope of practice under the NCO, an occupational therapy NCO, and psy-
supervision of a clinical or practical nurse. chiatric specialists (Table 2-20). Medical group
s. Intermediate Care Wards. These and brigade headquarters integrate the CSH NP
seven intermediate care wards (ICWs) with 20 section’s operations with those of the division and
ASMB mental health sections, and with the CSC
beds per ward are identical in personnel and units in the area. To the extent possible, the
equipment. They are under the supervision of CSH NP ward should receive only those NP and/
the nursing service control team. These wards or stress casualties who are too disturbed to re-
provide care for patients whose conditions vary ceive restoration treatment at Echelon II MTFs
from acute to moderate. The nursing care staff or CSC fatigue centers. These casualties
consists of a clinical head nurse, clinical nurses, include—
a wardmaster, practical nurses, and medical spe-
cialists (Table 2-19). The responsibilities and
functions of the clinical head nurses, clinical • Cases of psychosis, paranoia,
nurses (66H00), wardmasters, practical nurses, mania, and suicidal depression.
and medical specialists are the same as those
identified in paragraph r above, The clinical • Substance overdose or with-
nurses (66J00) assist the clinical head nurse in drawal requiring detoxification.
their duty performance. They perform first-level
nursing care duties within their scope of clinical • Mental or bodily symptoms
nursing activities. The lowest-grade medical which require CSH laboratory and x-ray capabili-
specialist is the designated vehicle operator for ty to rule out life- or limb-threatening organic
the section. causes.
The mission of the NP ward is to provide brief (2 treated and released to their units for duty, ad-
to 4 days) stabilization. The patients are then ministrative action, or rest and outpatient follow-
reevaluated to determine if they should be— up.
• Evacuated to a GH in the
COMMZ (or to CONUS) for further stabilization
and evacuation, definitive treatment, or admin-
• Evacuated to a FH or CSC
company in the COMMZ for RTD after 14 to 28
days of further reconditioning (depending on the
theater evacuation policy).
• Returned to duty in the CZ,
usually after transfer to a CSC unit’s recondi-
tioning center for 4 to 10 days further treatment.
The CSC reconditioning center may be collocated
with the CSH. The CSC center will maintain its
separate, nonhospital identity, but coordinates
closely with the CSHs NP service. The CSC
reconditioning center, if attached to the CSH, will
require administrative and logistical support.
The NP section’s consultation mission provides—
(1) Psychiatrist (60W00). This offi-
• Diagnosis and recommenda- cer is responsible to the Chief, Professional
tions for treatment for medical/surgical patients Services for the technical and administrative
with organic mental disorders on all other CSH management of this section. He supervises the
wards and in-patient admissions (emergency NP service staff, advises the CSH commander,
room). and provides technical supervision of NP/mental
health activities throughout the CSH. He
• Assistance, including stress examines, diagnoses, treats and or prescribes
debriefings, to all RTD and NRTD patients with treatment, and recommends disposition for
stress issues. patients and staff with NP and stress disorders.
• Assistance, including routine (2) Psychiatric/mental health nurse
and special stress debriefings, to all CSH staff, in (66C00). This officer is responsible for the tech-
close cooperation with leadership and the nical and professional management of the NP
chaplains. ward nursing staff He provides psychiatric nurs-
ing consultation to all other wards of the CSH.
Stress casualties (battle fatigue and misconduct He provides specialized nursing services for
stress behaviors) may be brought to the hospital patients with psychiatric and emotional problems
who do not require in-patient admission. Those and promotes mental health within the hospital
cases must be triaged by the NP service and and support area. This nurse performs liaison,
consultative, and training functions throughout functions of the ward. He provides psychiatric
the CSH to enhance the continuity and quality of nursing care duties within his scope of practice
patient care. under professional supervision.
(3) Psychiatric/mental health nurses (8) Psychiatric noncommissioned
(66C00). These officers are responsible to the officers (91F20). Under professional supervision,
psychiatrist and head nurse in the operation of these NCOs provide psychiatric nursing care
the ward and consultation throughout the within their scope of practice.
hospital. They develop and carry out nursing
care plans for each NP ward patient. These (9) Behavioral science noncommis-
nurses also assist in the training, supervising, sioned officer (91G20). Under professional super-
and technical management of subordinate NP vision, this NCO provides mental health assess-
ward staff, including the nonpsychiatrically ment and care within his scope of practice.
trained nurses and augmenting technicians.
(10) Occupational therapy noncom-
(4) Social work officer (73A67). missioned officer (91B20, ASI N3). This NCO iS
This officer is responsible to the psychiatrist. He responsible to the head nurse for establishing and
provides stress control prevention and treatment conducting the work therapy and recreational
throughout the hospital, and especially to the programs throughout the CSH, and especially the
minimum care (RTD-oriented) wards. He minimal care wards. Under professional super-
supports the NP ward by evaluating the RTD vision, he provides occupational therapy within
potential of patients, based on interviews with his scope of practice. If additional clinical
the soldier, plus data from the soldier’s unit. He guidance is required for planning and imple-
coordinates RTD, administrative disposition, or menting occupational therapy programs, occupa-
transfer to the CSC reconditioning center. The tional therapists (65A) are assigned to CSC com-
social work officer also assures effective use of panies and detachments, FHs, and GHs.
social service support agencies for patients and
CSH staff members. (11) Psychiatric specialists (91F10).
These specialists are responsible to the psy-
(5) Clinical nurse (66H00). This chiatric NCOs. Under professional supervision,
clinical nurse is responsible to the head nurse for they provide care and treatment for psychiatric,
direct and surgical nursing care to patients on drug, and alcohol patients within their scope of
the ward. He is cross-trained in stress control practice.
techniques and procedures.
u. Minimal Care Wards. These two
(6) Psychiatric noncommissioned minimal care wards of 20 beds each provide care
officer (91F30). This NCO assists the wardmaster for patients whose conditions vary from moderate
in the performance of his duties. He provides to minimal. These are convalescent patients with
psychiatric nursing care duties within his scope minimal requirements for nursing and medical
of practice under professional supervision. treatment. Staffing is composed of clinical
nurses, a wardmaster, practical nurses, and
(7) Psychiatric wardmaster (91F30). medical specialists (Table 2-21). Resupply of
This NCO assists the psychiatrist and nursing consumables is similar to that described for the
staff with the management and administrative ICU.
(forward). The staff is composed of pharmacy
officers, NCOs, and specialists (Table 2-22).
Three of the enlisted staff hold the ASI Y7 (sterile
pharmacy specialty) for the IV-additive program.
(1) Clinical nurses (66H00). These
nurses are responsible to the nursing service
control team for management and operations of
the ward. They supervise the enlisted nursing
staff and perform appropriate nursing duties.
(2) Wardmaster (91C30). This
NCO assists the clinical nurses in ward manage-
ment. He provides nursing care leadership and
supervises subordinate staff. This NCO also
works in concert with the chief wardmaster of (1) Chief, pharmacy services
the nursing service control team. (67E00). This officer is responsible to the Chief,
Professional Services (or the designated chief of
(3) Practical nurse (91C20). This ancillary service). He directs, plans, and partici-
practical nurse is responsible to the wardmaster pates in all hospital pharmaceutical activities. He
and, under professional supervision, performs is responsible for and maintains security within
nursing care duties within his scope of practice. the pharmacy area and monitors the storage,
security, and control to include inventories and
(4) Medical specialists (91B10). audit trails of controlled substances. He also acts
Under professional supervision, these specialists as a liaison between the professional staff and
provide medical treatment to patients within the logistics office for requisition of pharmaceu-
their scope of practice. tical items.
u. Pharmacy Services. The pharmacy (2) Pharmacy-officer (67E00). This
is responsible for quality control of pharmaceu- officer assists the Chief, Pharmacy Services in
ticals, distribution of bulk drugs, maintenance the performance of his duties. He supervises
and publication of the hospital formulary, and the other pharmaceutical staff and collects data for
intravenous (IV)-additive program. This section required reports.
maintains a registry for controlled drugs. The
pharmacy provides discharge medications for the (3) Pharmacy noncommissioned
required number of days to complete therapy and/ officer (91Q40). This NCO serves as the non-
or a 5-day supply of medications required for air commissioned officer in charge (NCOIC), phar-
evacuation out of theater. The pharmacy requisi- macy services. He is responsible for the work
tions required supplies through the logistics schedule of subordinate specialists; he is also
section to the supporting MEDLOG battalion responsible for ensuring adequate training for all
subordinate specialists. He prepares, controls, detection, diagnosis, treatment, and prevention
and issues pharmaceutical products under the of disease. He establishes and supervises an
supervision of a pharmacist. He also assists with appropriate laboratory quality control program.
the supervision of the section, providing technical He also supervises the blood bank activities.
guidance to subordinate personnel.
(4) Pharmacy and sterile pharma-
cy noncommissioned officers (91Q30). These NCOs
assist the pharmacy officer and NCO in their duty
performance. They prepare, control, and issue
pharmaceutical products, ensuring compliance
with Army and Federal rules, laws, and
regulations relative to pharmacy operations. One
of these specialists holds the Y7 ASI. This
specialist serves as the NCOIC of the sterile
products service. He performs sterile technique
procedures in the preparation of items such as
IV-additives which are used to combat infection (2) Medical laboratory noncom-
and to restore and maintain electrolyte and nutri- missioned officer (91K40). This NCO advises and
tional balance. assists the laboratory officer in laboratory opera-
tions, supply economy and inventory manage-
(5) Pharmacy/sterile pharmacy ment, advanced technical procedures, and ad-
specialists (91Q10). Under professional super- ministrative requirements. He provides technical
vision, these specialists perform pharmaceutical guidance and supervision to the subordinate staff.
duties within their scope of duties. Two of these
specialists will hold the Y7 ASI. Their duties as (3) Medical laboratory specialists
sterile pharmacy specialists will be the same as (91K30). These specialists Perform elementary
those identified in paragraph (4) above. and advanced examinations of patient-derived
specimens (including suspect biological warfare
w. Laboratory Services. This section specimens) to aid in the diagnosis, treatment, and
performs a limited array of analytical procedures prevention of disease.
in hematology, urinalysis, chemistry, micro-
biology, and blood bank. The staff is composed of (4) Medical laboratory specialist
a clinical laboratory officer, laboratory NCOs, and (91K20). This laboratory specialist performs clini-
medical laboratory specialists (Table 2-23). The cal laboratory procedures in hematology, bio-
91K10 specialists hold the M4 ASI in blood chemistry, serology, bacteriology, parasitology,
banking procedures in order to provide back up and urinalysis. He collects and processes speci-
capability for the blood bank section. mens for shipment to supporting laboratories and
stores and issues blood.
(1) Clinical laboratory officer
(71E67). This officer is responsible to the Chief, (5) Medical laboratory specialists
Professional Services (or the designated chief of (9IK10) (ASI M4). These specialists perform
ancillary services) for management and operation elementary clinical laboratory and blood banking
of the laboratory section. He directs the per- procedures under the supervision of the labora-
formance of laboratory procedures used in the tory NCO.
x. Blood Bank. This section provides of this section. He performs and interprets all
all routine blood grouping and typing, ab- diagnostic radiological and fluoroscopic proce-
breviated cross-matching procedures, emergency dures, including special vascular studies and
blood collection, and blood inventory man- imaging, on patients referred by other physicians.
agement. It has the capacity to store and issue
liquid blood components and fresh frozen plasma.
Staffing for this section includes a medical lab-
oratory NCO and medical laboratory specialists
(Table 2-24). All blood bank personnel hold the
(2) Radiology specialist (91P30).
This specialist assists the radiologist in the per-
formance of his duties, to include technical guid-
ance to subordinate personnel. He assists in the
technical and administrative management of this
(l) Medical laboratory noncom- section.
missioned officer (91K30). This NCO is respon-
sible to the Chief, Laboratory Services for the (3) Radiology sergeant (91P20).
management and operation of this section. He This NCO performs duties within his scope of
performs advanced procedures in all phases of training under the supervision of the radiology
blood banking. He supervises subordinate spe- specialist.
cialists in the performance of their duties.
(4) Radiology specialists (91P10).
(2) Medical laboratory specialists These specialists perform duties within their
(91K20/91K10). The duties and functions of the scope of training under the supervision of the
remaining staff are the same as the correspond- x-ray NCOs. They also perform vehicle operator
ing staff in paragraphs w(4) and (5). duties for the section.
y. Radiology Service. This section z. Physical Therapy Service. This sec-
provides radiological services to all areas of the tion provides inpatient physical therapy services
hospital and operates on a 24-hour basis. Staffing and consultation for patients. The primary
includes a radiologist, x-ray NCOs, and x-ray wartime role of this section is evaluating and
specialists (Table 2-25). treating neuromusculoskeletal conditions and
providing burn/wound care to patients with
(1) Diagnostic radiologist (61R00). potential for RTD within the corps evacuation
This officer is responsible to the Chief, Profes- policy. During mass casualty situations, physical
sional Services (or the designated chief of ancil- therapy personnel may be utilized in managing
lary service) for the management and operation minimal or delayed patients, or augmenting the
orthopedic staff. The staff is composed of a (1) Hospital chaplain (56A00).
physical therapist and physical therapy sergeants This chaplain, supervised by the hospital head-
(Table 2-26). quarters chaplain, coordinates the program of
religious ministries, including workshops, pas-
toral counseling, and religious education for the
hospital. He supervises the activities of the other
ministry team staff.
(2) Senior chaplain’s assistant
(71M20). This senior chaplain’s assistant is re-
sponsible to the hospital chaplain and assists him
in his duties. He also supervises the activities of
the chaplain’s assistant.
(1) Physical therapist (65B00). (3) Chaplain’s assistant (71M10).
This officer is responsible to the Chief, Profes- This assistant is responsible to the senior chap-
sional Services (or the designated chief of ancil- lain’s assistant. He prepares the chapel for
lary service) for the management and supervision worship and prepares sacraments of Protestant,
of physical therapy services. The physical thera- Catholic, Orthodox, and Jewish faiths.
pist plans and supervises physical therapy pro-
grams upon referral from medical officers. This
officer also provides guidance in the areas of 2-6. The Hospital Unit, Surgical
physical fitness, physical training, and injury
prevention. The HUS augments the HUB to form the CSH.
The HUS is composed of the following sections:
(2) Physical therapy sergeants
(91B20, ASI N9). These physical therapy ser- a. Unit Headquarters. This section
geants are responsible to the physical therapist. provides augmentation to the HUB to assist in
They provide physical therapy treatment to pa- nursing supervision, hospital operation, and
tients within their scope of practice. company headquarters operation. The staff is
composed of the HUS commander, an assistant
aa. Hospital Ministry Team. This sec- chief nurse, a field medical assistant, a detach-
tion is composed of a chaplain, a senior chaplain’s ment NCO, and a patient administration spe-
assistant, and a chaplain’s assistant to provide cialist (Table 2-28).
religious support and pastoral care ministry for
assigned staff and patients (Table 2-27).
(1) Hospital commander (61J00). Staffing includes a medical supply sergeant, a
This officer, in his capacity as the HUS com- supply sergeant, medical supply specialists, and
mander, ensures a smooth and functional inte- supply specialists (Table 2-29).
gration of unity of the HUS with the HUB. Once
the two units are combined to form a CSH, this
officer performs the duties of a surgeon in OR C.
(2) Assistant chief nursing service
(66A00). This officer functions in unison with
the chief nurse of the HUB in providing the
necessary planning, execution, and direction for
(3) Field medical assistant (70B67).
This officer assists the HUS commander in the
areas of organizational administration, supply,
training, operation, transportation, and patient (1) Medical supply sergeant
evacuation. When collocated with the HUB, this (76J20). This NCO is responsible to the medical
officer will perform duties as the hospital plans supply NCO (HUB) for medical supply operations,
officer. stock control, and medical assemblage manage-
ment. He is responsible for the development and
(4) Detachment noncommissioned preparation of plans, maps, overlays, sketches,
officer (91B40). The detachment NCO is the and other administrative procedures related to
principal enlisted assistant to the HUS com- employment of the HUS supply and service
mander. He maintains liaison between the HUS division.
commander and assigned NCOs, provides guid-
ance to enlisted members of the HUS, and repre- (2) Supply sergeant (92Y20). This
sents them to the commander. When the HUB NCO is responsible for general supply operations,
and HUS unite to form a CSH, he also functions to include supervision of the supply specialists.
as the first sergeant of the medical holding de- He maintains accountability for all equipment
tachment. As such, he is supervised by the HUB organic to the HUS.
company headquarters commander who func-
tions as the commander, medical holding detach- (3) Medical supply specialists
ment. (76J10). These specialists are responsible to the
medical supply sergeant for performing desig-
(5) Patient administration special- nated medical supply and equipment functions.
ist (71G10). This specialist works in concert with
the PAD of the HUB in preparing and main- (4) Supply specialists (92Y10).
taining patient records, to include statistical data These supply specialists assist the supply ser-
for required reports. geant in his duty performance. They request,
receive, inspect, load, unload, segregate, store,
b. Supply and Service Division (Aug- issue, and turn in organizational supplies and
mentation). Because of the increased work load equipment. One of the specialists will function
associated with the HUS, this section augments as the armorer. The armorer maintains the
the supply and service division of the HUB. weapons storage area, issues and receives small
arms and ammunitions, and performs small arms d. Triage/Preoperative/Emergency
unit maintenance. Medical Treatment Section. This section provides
for the receiving, triaging, and stabilizing of in-
c. Operating Room/Central Material coming patients. The staff receives patients,
Service Control Team. This team provides aug- assesses their medical condition, provides EMT,
mentation to the HUB to assist in supervising and triages them to the appropriate nursing unit
and scheduling the nursing staff and in preparing or health service. The staff will be trained in
and maintaining the OR/CMS. The ranks and both advanced ACLS and ATM. The staff moni-
titles of the personnel (Table 2-30) are designed tors patient conditions and prepares those re-
to interface with the HUB OR/CMS control team quiring immediate surgery for the OR. This
(Table 2-11) to provide support without dupli- section works in conjunction with the triage/
cating duties and responsibilities. preoperative/EMT section, located in the HUB,
to handle the overall work load for the hospital.
This section gives the hospital commander
• Personnel can be used to sup-
plement HUB EMT with its equipment remaining
loaded for use as a jump or movement echelon.
• Part of the equipment and staff
can be used to have a sick call or minor injury
area with all major trauma sent to the main
• The hospital can have two fully
(1) Anesthesiologists (60N00). This
physician administers or supervises administra- operational EMTs. This would require the head-
tion of anesthetics to patients. quarters to carefully monitor and evaluate the
admissions and OR requirements of these two
(2) Clinical head nurse, anesthe- sections if both were treating major trauma
tist (66F00). This officer performs nursing duties patients.
in the care of patients requiring general or re-
gional anesthesia, respiratory care, cardiopul- The staffing of this section is identical to that of
monary resuscitation, and/or fluid therapy. the HUB (Table 2-9). The duties and responsi-
Under the supervision of an anesthesiologist, he bilities are the same for the corresponding posi-
administers general and regional anesthesia for tions as identified in paragraphs 2-5 i (1)--(8).
surgical patients as required.
e. Operating Room C. This section
(3) Assistant head nurse, operat- provides general and ear, nose, and throat (ENT)
ing room (66E00). This assistant head nurse surgical services with two OR tables for a total of
performs nursing duties in any phase of the op- 36 hours of table time per day. The staff for this
erative process for patients undergoing all types section includes general surgeons, clinical and
of surgery and provides safe supplies and equip- OR nurses, an OR NCO, and OR specialists
ment for operative services. (Table 2-31).
having diseases, injuries, or disorders of the geni-
tourinary tract. He performs required surgery.
(1) General surgeons (61J00).
These surgeons examine, diagnose, treat or pre- (2) Thoracic surgeon (61K00).
scribe courses of treatment and surgery for pa- This physician examines, diagnoses, and treats
tients having injuries or disorders with surgical or prescribes courses of treatment and surgery
conditions, and perform required surgery. As for patients having surgical diseases or injuries
noted in Table 2-31, the commander, HUS also of the thorax and vascular system. He performs
functions as a general surgeon in OR C. This required surgery.
requirement is accounted for in the unit head-
quarters and is not included in the total authori- (3) Orthopedic surgeons (61M00).
zations for the OR. These surgeons examine, diagnose, and treat or
prescribe courses of treatment and surgery for
(2) Other assigned personnel. The patients having disorders, malformations, dis-
duties and responsibilities of the OR nurse, clini- eases, or injuries of the musculoskeletal systems.
cal nurse (anesthetist), OR NCO, and OR spe- They perform surgical operations as required.
cialists are the same as identified in paragraphs
2-5l (3) through (6). (4) Clinical nurse, anesthetists
(66F00). These anesthetists perform nursing
f. Operating Room D. This section duties in the care of patients requiring general or
provides primarily orthopedic, thoracic, and uro- regional anesthesia, respiratory care, cardio-
logical surgical services with two OR tables for a pulmonary resuscitation, and/or fluid therapy.
total of 36 hours of table time per day. Staffing Under the supervision of an anesthesiologist,
for this section includes a thoracic surgeon, a they administer general and regional anesthesia
urologist, an orthopedic surgeon, a clinical nurse for surgical patients, as required.
(anesthetist), an OR nurse, an OR NCO, and OR
specialists (Table 2-32). (5) Operating room nurses (66E00).
These nurses perform nursing duties in any
(1) Urologist (60K00). The urolo- phase of the operative process for patients under-
gist examines, diagnoses, and treats or prescribes going surgery. They also provide safe supplies
courses of treatment or surgery for patients and equipment for operative services.
(6) Other assigned personnel. The specialist are identical to those listed in
duties and responsibilities of the remaining OR paragraph 2-5 n.
D staff will be the same as the corresponding staff
in paragraph 2-5l, with one exception. The OR h. Central Materiel Service. This sec-
specialist, 91D10, is the designated vehicle op- tion operates two CMS units which provide for
erator for this section. the sterilization of OR equipment, surgical instru-
ments, and supplies, as well as for sterile supplies
g. Orthopedic Cast Clinic. This section for other patient care areas. This section operates
augments the orthopedic cast clinic of the HUB in conjunction with the CMS section of the HUB
to provide casting, splinting, and traction services under the control of the OR/CMS control team.
throughout the hospital. As with the multiple Normally, each CMS would function primarily to
triage, preoperative, and EMT sections, this support the activities of its associated OR and
second orthopedic and cast clinic gives the hos- wards. The staffing, duties, and responsibilities
pital commander various employment options. are identical to those identified in Table 2-15 and
The staffing consists of orthopedic NCOs and an paragraphs 2-5 o (1) and (2).
orthopedic specialist (Table 2-33).
i. Intensive Care Ward. These nursing
units provide five ICUs of 12 beds each for criti-
cally injured or ill patients. The clinical nurses
hold an ASI (8A) as ICU nurses. When func-
tioning as a CSH, this section is under the super-
vision of the Nursing Service Control Team
(HUB). The staff performs recovery room nursing
care for those patients who require close observa-
tion, vital sign monitoring, IV fluid replacement,
and respiratory assistance. The staff consist of a
clinical head nurse, clinical nurses, a wardmaster,
practical nurses, and medical and respiratory
specialists (Table 2-34). The duties and respon-
(1) Orthopedic noncommissioned sibilities are the same as the corresponding posi-
officer (91B30, ASI P1). This NCO supervises tions identified in paragraphs 2-5r (1) through (8).
the orthopedic personnel in both the HUB and
HUS and performs technical and administrative
duties as directed by the orthopedic surgeon.
(2) Orthopedic noncommissioned
officer (91B20, ASI P1). This NCO helps in the
treatment of orthopedic patients and supervision
of subordinate orthopedic specialists. He or-
ganizes work schedules, assigns duties, counsels
personnel, and prepares evaluation reports under
the supervision of the orthopedic NCO.
(3) Orthopedic specialist (91B10,
ASI P1). The duties and responsibilities of this
J. Radiology Service. This section pro-
vides augmentation to the radiology section of the
HUB. Staffing consists of a radiologist, x-ray
NCOs, and x-ray specialists (Table 2-35).
(1) Diagnostic radiologist (61R00).
This officer conducts, interprets, and directs
x-ray and fluoroscope examinations to include
administration of ionizing radiation and patient
care. He assists the radiologist, radiology service, (2) Other assigned personnel. The
HUB with the management of the section. He duties and responsibilities of the remaining staff
also provides technical supervision to the sub- are the same as those identified in paragraphs
ordinate staff. 2-5 y (2), (3), and (4).
COMMAND, CONTROL, AND COMMUNICATIONS
OF THE COMBAT SUPPORT HOSPITAL
3-1. Command and Control a. Staff Responsibilities. Each staff
element of the hospital is responsible for adhering
The medical command (MEDCOM) is the senior to signal support policies, procedures, and
medical headquarters assigned to a TO. It standards in their daily operations. The hospital
controls the majority of its assigned units through communications chief coordinates telecom-
subordinate COMMZ medical brigades. The munications interface requirements with higher
medical brigade assigned to the COSCOM is the headquarters and with the supporting signal unit.
senior medical C2 headquarters in the corps; it
controls nondivisional medical units assigned to b. Mobile Subscriber Equipment Area
the corps through its subordinate medical group Communications System. Mobile subscriber
headquarters. The medical group with its equipment is the area common-user voice
attached units provides corps-level support to the communications system within the corps. It is
divisions and area CHS to troops operating within the backbone of the corps system and is deployed
its sector of responsibility. The CSH is normally from the corps rear boundary forward to the
employed in DS of a division and GS of a corps. maneuver battalion’s main command post. It
The hospital is assigned to a medical brigade for provides a secure mobile, survivable communi-
C2. It may be further assigned to a medical cations system capable of passing voice, data,
group. The designation of the type of C2 and facsimile (FAX) throughout the corps.
headquarters depends on factors such as mission, Additionally, it provides a direct interface to
size of force, type of operation, anticipated echelon above corps, other Services, NATO,
duration, and medical resources assigned to the combat net radio (CNR), and commercial com-
deployed force. When the CSH is DS, it will munications systems. This system is composed
establish liaison and provide medical advice to of multiple communications nodes with network
the supported unit. During initial buildup or features which automatically bypass and reroute
contingency operations, the senior medical C2 communications around damaged or jammed
headquarters may be a medical brigade or medical nodes. It integrates the functions of transmission,
group. switching, control, and terminal equipment (voice
and data) into one system and provides the user
with a switched telecommunications system
3-2. Communications extended by mobile subscriber radio telephones.
It is integrated within the corps and division force
Management and control of CHS operations is structure. Nodes are deployed from the corps
dependent on the hospital headquarters’ ability rear boundary forward to the maneuver brigade
to communicate with its staff, the corps medical rear area based on geographical and subscriber
brigade or group, elements of the medical density factors. Node centers (NCs) makeup the
evacuation battalion, and other CSS units. system’s assemblage. Extension switches permit
Hospital communications assets include ampli- wire-line terminal subscribers (telephone, FAX,
tude modulation (AM) and FM radios and mobile and data) to enter into the total area commu-
subscriber equipment (MSE). See Appendix E, nications system. Radio access units (RAUs) let
Communications, Automation, and Position/ the users of mobile subscriber radiotelephone
Navigation Systems. Communications support is terminals (MSRTs) communicate with other
provided by the area support signal unit. mobile and wire telephone users throughout the
AO. The system control centers (SCCs) provide The CSH will participate in the first four of the
the processing capability to assist in overall above functional areas. Figure 3-1 shows how
network management. The MSE system lets the system integrates the functions of
subscribers communicate with each other using transmission, switching, control, and terminal
fixed directory numbers regardless of a equipment.
subscriber’s battlefield location. The MSE system
is comprised of the following five functional areas: (1) Area coverage. Area coverage
means that MSE provides common-user support
• Area coverage. to a geographic area, as opposed to dedicated
support to a specific unit or customer. Node
• Subscriber terminals. centers are under the control of the corps signal
• Wire subscriber access.
(2) Subscriber terminal (fixed).
• Mobile subscriber access. The MSE telephone, mobile radiotelephone,
FAXs, and data terminal, as part of the area
• System control. common-user system (ACUS), are user-owned
and operated. The hospital’s communications terminals used by the hospital are digital, four-
chief is responsible for running wire to the wire voice, as well as data ports for interfacing
designated junction boxes. These boxes tie the the AN/UXC-7 FAX, the TACCS and the Medical
hospital MSE telephones into the extension Transportable Computer Unit (MEDTCU) as
switches which access the system. The subscriber depicted in Figures 3-2 and 3-3.
(3) Wire subscriber access. Wire d. Combat Net Radio System. The
subscriber access points provide the entry points CNR equipment in the hospital includes both the
(interface) between fixed subscriber terminal equip- improved high-frequent y radio (IHFR) system
ment owned and operated by users and the MSE and the single channel ground and airborne radio
area system operated by the supporting signal system (SINCGARS). These systems will serve
unit. Figure 3-4, Figure 3-5 (page 3-7), and as a primary means for voice transmission of
Figure 3-6 (page 3-8) show the MSE switchboard C2 information and as a secondary means for
configurations through which the hospital may tie data transmission. Data transmission will be
into the area system. The two types of interface required when data transfer requirements
equipment are- cannot be met by the MSE system. The improved
high-frequency AM radio series provide mid-
• The signal distribution to-far-range communications capability. They
panel (junction box) J-1077. Each panel provides interface with other AM high-frequency radios
up to 13 subscriber access points. and have push-button frequency selection. The
SINCGARS series' FM radios are designed for
• Remote multiplexer com- simple and quick operation using a 16-element
biners which provide access for 8 subscriber keypad for push-button tuning. They are capa-
access points. ble of short-range operation for voice or digital
data communications and interfacing with the
See FM 11-30 for definitive information per- AN/VRC-12 series of FM radios. They also can
taining to an MSE area communications operate in a jam-resistant, frequency-hopping
system. Figure 3-7 (page 3-9), Figure 3-8 (page mode.
3-10), and Figure 3-9 (page 3-11) depict examples
of the hospital’s wire net diagram. The hos-
pital commander will designate the hospital’s e. Combat Support Hospital Radio
wire net system based on the mission. Nets. The CSH and its staff depend on both
AM and FM radios and area communications
c. Mobile Subscriber Terminal. The systems to operate. The hospital FM radio net is
MSE terminal is the AN/VRC-97 MSRT. The shown in Figure 3-11 (page 3-13) (also see
MSRT, which consists of a very high-frequency Appendix E). The hospital monitors the following
radio and a digital secure voice terminal, is a FM nets:
vehicle-mounted assembly. It interfaces with the
MSE system through an RAU. The primary use • Hospital commander—medical
of the MSRT is to provide mobile subscriber brigade/group command net.
access to the MSE area network. The MSRTs
also operate in command posts to allow access
to staff and functional personnel. The MSRT user • S2/S3—medical brigade/group
has a KY 99 minterm telephone connected to command net.
the radio mounted in his vehicle. As long as the
radio unit has line of sight contact with the • Supported CSS FM nets.
RAU and the operator has properly affiliated, it
connects to the area system. The operational
planning range is 15 kilometers from any RAU. • S4 (Supply Officer, [U.S.
Figure 3-10 (page 3-12) is a typical MSRT Army])-supporting and supported logistical CSS
interface into the area system. FM nets.
• Triage/preoperative/EMT--used • Using terrain features such as
to control operation of the medical evacuation and hills, vegetation, and buildings to mask trans-
heliport operations. missions.
• Commander, HUS—hospital • Maintaining radio and radio-
command net. listening silence; using the radio only when
f. Combat Support Hospital Opera-
tions Net—AM-1HFR. The hospital operations • Distributing codes on a need-
net (Figure 3-12, page 3-14) uses an AN/GRC- to-know basis.
193A radio. This net is used to facilitate patient • Using only authorized call
management, air and ground evacuation, and signs and brevity codes.
medical regulation of patients. This net links the
hospital with the medical brigade/medical group • Using authentication and en-
which is the net control station (NCS) for the cryption codes specified in the current signal
corps CHS operations net. operation instructions (S0I).
g. Signal Security. As part of the • Keeping transmissions short
overall security program, CSH elements must (less than 20 seconds if possible).
practice signal security. The hospital operations
section is responsible for signal and commu- • Reporting all COMSEC dis-
nications security. Some considerations include— crepancies to appropriate authorities.
DEPLOYMENT AND EMPLOYMENT
OF THE COMBAT SUPPORT HOSPITAL
4-1. Threat for the sustainment of forces. Planning CHS is a
continuous and demanding process. The hospital
a. The military threat facing the US commander and his staff must constantly assess
Armed Forces is massive. For years, the Com- new information for its impact on current and
munist military forces were considered to be our future support requirements. Hospital comman-
major adversary. Now we must not only remain ders must understand how their actions should
cognizant of the potential threat of major global complement their higher headquarters plan.
powers, but we must also maintain an awareness Misinterpretations can lead to counterproductive
of the various threats and trouble spots of Third actions and potentially disastrous results. Two
World countries. Once considered not to be a primary factors hospital planners must be knowl-
major threat, the Third World regional powers edgeable of are the higher commander’s intent
pose a threat to US security and interests world- and the mission, enemy, terrain, troops, and
wide. These countries now have the capability of time available (METT-T). The planning process
conducting hostile activities, and during wartime for future missions should not be isolated from
or periods of crisis, of supporting espionage, current support actions. The planning process
subversion, and sabotage operations. Highly should be flexible and adaptive to the situation
destructive regional wars remain a danger. and the hospitals’ mission. Combat health
Potential aggressors will be well armed with support elements should be deployed in the
modern aircraft and armored forces. They will appropriate mix, in a logical sequence, based on
likely be equipped with highly sophisticated and the supported forces.
state-of-the-art weaponry systems. The prolifera-
tion and use of NBC weapons by developing
nations will continue to pose a threat. They could
attack using NBC weapons, powerful conven- 4-3. Mobilization
tional weapons, or an assortment of both. The
US Army will most likely face regional threats a. Concept of Operations.
attempting to expand their sphere of influence by
force. (1) In the event of contingencies
in support of OOTW or war, the DOD initiates
b. Another major threat to US forces appropriate action for the deployment of forces in
deployed outside continental United States response to the scenario. Based on the situation,
(OCONUS) is that of a medical threat. Elements selected Active Component (AC) and Reserve
of the medical threat include naturally occurring Component (RC) CSHs and other units are
infectious diseases (also referred to as endemic alerted through command channels. For those
diseases), environmental extremes, and combat units located in CONUS, the United States Army
stress. For a detailed discussion of medical threat Forces Command (FORSCOM) uses the appro-
elements, see FM 8-10. priate CAPSTONE trace and programs, the Time-
Phased Force Deployment Data List (TPFDDL)
4-2. Planning Combat Health Support based on the theater commander’s requirements,
Operations and the air and sea resources available. For
deployable AC hospitals, an increase in readiness
Combat health support is an integral part of the posture (defense readiness conditions [DEFCON])
force structure and is vital to all contingencies is directed by the post or installation commander,
or by higher headquarters. For RC hospitals, Appendix F can be used as a guide for developing
mobilization notification constitutes an increase deployment operation procedures in support of
in readiness posture. movement by air and surface modes, or a com-
bination thereof. The checklists are applicable to
(2) Deployment operations for hos- both AC and RC units. The checklists are
pital readiness validation are controlled through detailed only as a guide for commanders.
the post or installation emergency operations Installation mobilization stations and/or higher
center (EOC) according to established plans and headquarters may prescribe different procedures
regulations. The EOC plans and coordinates all for your unit.
deployment preparation support for the deploying
hospital and monitors and controls all facets of (2) Active Component hospitals
the deployment operation, to include reporting to maintain the capability necessary to achieve a
higher headquarters. deployment posture in the time required by any
alert warning order or deployment instructions
(3) The hospitals may deploy by received. For planning purposes, the readiness
land, sea, or air (or a combination of these posture maintained is consistent with the shortest
modes) from locations designated by higher notification period presented in the mobilization
headquarters. Priority of effort is given to those plan.
modes of movement outlined in current plans.
(3) Reserve Component hospitals
(4) Active Component hospitals maintain the readiness posture necessary to meet
maintain the capability for emergency deploy- planned deployment dates contained in current
ment on short notice to execute assigned missions. FORSCOM and mobilization documents. Upon
arrival at the designated mobilization site, hos-
(5) RC hospitals must attain and pitals are placed in an increased or advanced
maintain the capability for mobilizing on short deployability posture based on the published
notice and arriving at their designated mobili- priorities of plans for which the hospitals are
zation site according to unit mobilization plans. listed. The hospitals are managed through
the RC chain of command, with input by the
(6) Once mobilization is validated, mobilization installation commander during the
hospitals prepare for deployment on short notice premobilization period.
(72 hours or less). During validation, appropriate
status reports are submitted to higher head- (4) All hospitals are scheduled for
quarters. deployment validation by unit line number based
on the published validation schedule. Hospitals
b. Conduct of Operations. can be expected to deploy within 72 hours fol-
lowing validation. Actual deployment date and
(1) Commanders of deploying hos- times are as directed by higher headquarters.
pitals develop movement plans and TSOPs
to accomplish the necessary preparations for
deployment. Provisions for accomplishing all 4-4. Deployment
required training and other requirements to be
accomplished during all phases of the deploy- a. When directed by higher head-
ment are identified. The checklists contained in quarters through the port call or airlift message,
the CSH will move to the port of embarkation • Personnel replacements.
(POE) for deployment. Deployment from the POE
will be as directed by the United States • Uniform requirements.
Transportation Command. Upon arrival at the
theater point of entry, it is essential that con- • Emergency warning signals.
tact with the assigned medical brigade or group
be made immediately. Normally, the medical • Religious support.
brigade or group has liaison personnel to meet
and assist the hospital staff with coordination and •
movement to its AO. As equipment and supplies Vehicle and unit movement
are off-loaded, they are moved to a designated requirements.
receiving area for consolidation and movement.
An inventory for accountability and damage • Geneva Conventions (see
assessment is conducted. Vehicles are serviced Appendix G).
and necessary repairs are made, or coordination
is made with the supporting maintenance element • Supply support activities and
for the repairs. Documentation for replacement procedures (all classes).
of unusable supplies or equipment damaged
beyond repair is initiated through the medical b. In a force projection Army, METT-T
brigade or group headquarters element. Vehicle will drive the amount of supplies required to
loads are adjusted for convoy operations. For support the force. For planning purposes, the
equipment that was transported separately from hospital normally deploys with 10 days of medical
the hospital, coordination is made for receiving supplies; the medical assemblage for each work
and transporting it upon arrival. Once the hos- area contains a basic load of 3 days of supply; and
pital has moved to its AO, the medical brigade or the medical supply set maintained by the supply
group staff elements conduct formal personnel and service division contains a 7-day basic load
in-processing and an orientation on current for the entire hospital. In a maturing theater,
operating policies and procedures. The orien- medical resupply is accomplished by pre-
tation includes information on the following: configured resupply packages until the corps
MEDLOG battalion (forward) has been estab-
• Mission update, to include geo- lished. These “push packages” are throughput
graphical support area. directly to the hospital via the transportation
system. These packages may be pre-positioned
• Combat health support issues. “mobilization stocks,” or may be built and shipped
from the Defense Logistics Agency (DLA) depot
• Host-nation (HN) support. system. Hospital logistics personnel coordinate
with their next higher command headquarters
for all logistical support to include resupply.
• Local laws and customs. Early deploying hospitals that arrive prior to their
higher medical C2 headquarters must coordinate
• Threat update. with port transportation personnel for shipment
and receipt of supplies and equipment. Once the
• Security requirements. MEDLOG battalion (forward) has been estab-
lished, hospital logistics personnel coordinate
• Personnel restrictions. directly with the MEDLOG battalion for resupply
of Class VIII materiel. All other resupply • Two ICU Wards
is requisitioned through higher headquarters
with the appropriate supporting organization. • Two CMSs
Effective coordination is the key to responsible
logistical support. To be effective it must be early • Ortho Cast Clinic
and it must be often.
Elements of the following should also be included
c. For maximum use of the CSH, the to provide necessary support: company head-
entire organization should deploy together. How- quarters (HUB), supply and service division
ever, due to its limited mobility and availability (HUB), PAD, and nutrition care division. It is
of transportation support requirements, it may critical to the operation of the hospital that
be necessary to deploy by echelons. If required the first echelon include a heavy complement of
to move by echelons, the following sequence is utilities personnel and equipment.
(3) Third echelon. This echelon
(1) First echelon. Advanced/quar- should include—HUB:
• Neuropsychiatric Service and Ward
(2) Second echelon. This echelon
should include—HUB: • Operating Room B Module
• Hospital Headquarters • Inpatient Medicine A Module
• Operating Room A Module • Two ICWs
• Two ICWs • Two Minimal Care Wards
• Laboratory • Two CMSs
• Two ICU Wards
Elements of the following should be included
• Pharmacy in this echelon: company headquarters (HUB),
supply and service division (HUB), and PAD.
• Litter Bearer Section
(4) Fourth echelon. All remaining
—Hus: elements of the hospital.
• Supply and Service Division
a. The CSH is normally employed in
• Operating Room/CMS Control Team the corps AO on the basis of 2.4 per division
supported. It will provide hospitalization for modular, personnel (TEMPER) and international
those patients who require stabilization for organization for standardization (ISO) system.
further evacuation, or who will RTD within the See TC 8-13 for a recommended design of these
corps evacuation policy. Patients are received systems for hospital operations. Because of its
from the MASH and supported corps area by air size, relocating the CSH should be limited. With
and ground ambulance. The patients are triaged, required personnel, it is estimated that 72 hours
treated, and evacuated, or RTD. are needed to erect the hospital completely for
operations. The same amount of time is needed
b. It is estimated that the hospital will to prepare for relocation. The commander may
require an area approximately 350 meters X 350 designate certain hospital elements to be erected
meters to establish and operate. The total area is on a priority basis to expedite the receiving of
dependent upon the hospital’s mission and terrain patients upon relocation.
feature. This facility, by virtue of its dependency
on other support units, must locate in an area c. The CSH can be tailored to support
where it can be easily supported by elements of specific military operations. It may have surgical
the corps support group, the corps signal brigade, and/or medical teams attached to enhance its
the corps engineer brigade, and the COSCOM capabilities. When the HUS is employed sepa-
movement control center (MCC). Direct coordina- rately from the CSH, it requires attachment to
tion between the CSH is usually required with— another unit for support.
• The multifunctional corps sup- d. The CSH may be employed to sup-
port battalion (CSB) and its subordinate elements port rear operations in the corps or COMMZ.
for specific-type logistics support (to include
mortuary affairs [MA] and evacuation support for e. The size and composition of health
deceased patients). services in support of military operations will be
tailored based on—
• The corps signal battalion or
area support signal unit for external signal • Mission.
• Size of force being supported.
• The corps engineer battalion or
area support engineer unit for engineer support. • Projected patient work loads.
• The COSCOM MCC or servic- • Anticipated civic action pro-
ing MCC for transportation support and highway grams.
• Availability of evacuation
• The corps provost marshal or assets.
base commander for security.
• Evacuation policy.
• The medical brigade or group
for air and ground ambulance support. f During the initial stages of military
operations, CHS to the US forces will be austere
Appendix H depicts an example of a functional and limited to the unit’s organic medical capa-
layout using the DEPMEDS tent, extendable, bilities. A short theater evacuation policy is
normally established and tailored hospital sup- disruption, the CSH should move in echelons.
port is required. Projected patient work loads Displacement by echelons is contingent upon the
will dictate the composition of these hospitals. higher commander’s intent, the tactical situation,
The modular design of these hospitals allow aug- and the availability of support requirements.
mentation as needed.
b. Conduct of Operations.
4-6. Hospital Displacement (1) Warning order.
a. Concept of Operations. (a) A move is usually initi-
ated by a warning order issued by the medical
(1) The medical brigade or group brigade or group headquarters. The warning
commander moves the CSH in support of order serves notice of a contemplated action or
sustainment operations. Hospital displacement order that is to follow. The amount of detail
may be in response to forward moves in support included in a warning order depends on the time
of tactical operations, or rearward moves during available, the means of communications, and
a retrograde to maintain appropriate distances the information necessary for the hospital
from the forward line of own troops (FLOT). The commander. Warning orders are brief oral or
medical brigade or group commander normally written orders.
issues orders, either verbally or in writing, to the
hospital commander. Frequently, the time to (b) Upon receiving the warn-
respond to orders is short; therefore, the hospital ing order, the hospital commander analyzes the
commander must disseminate his guidance to his mission and provides planning guidance to his
staff in the most expedient method. Upon staff. Using the medical brigade’s or group’s
receiving the commander’s guidance, the hospital service support annex, status reports, and other
staff conducts the mission analysis, incorporating appropriate documents, the hospital staff for-
changes based on new information or situation. mulates the hospital service support estimate for
The hospital saves time by rehearsing moves, the commander’s approval. (Field Manual 8-55
using knowledge from past experience, and discusses staff estimates and functions in greater
maintaining a detailed TSOP. detail.) With the acceptance and approval of
the staff estimates, the hospital commander pro-
(2) The hospital operations section vides his decision and concept of operations.
develops the OPORD in accordance with the Concurrently with the staff estimate sequence,
medical brigade’s or group’s plan, FM 101-5, FM other hospital personnel conduct preliminary
8-55, and the TSOP. The hospital commander, in equipment checks and equipment loading proce-
consultation with the hospital XO, approves the dures. Based on the commander’s decision, the
OPORD. The hospital commander ensures that PAD coordinates with the medical brigade or
the move is coordinated with higher headquarters group to effect the transfer of patients to other
and all supported elements. All supported ele- MTFs.
ments must be aware of when medical operations
at the current location will be curtailed and the (c) In preparation for dis-
date and time of opening of the operation at the placement, the hospital commander should
new site. Hospital displacement necessitates the organize the hospital into manageable echelons,
transfer of patients and medical operations to preserving hospital integrity as much as possible.
other MTFs. To minimize hospital operations Preparation for displacement requires—
• Identifying external distributing the OPORD. The OPORD provides
support requirements; for example, MHE. hospital staff and personnel the information
needed to carry out an operation. Preparation of
• Phasing down and this order normally follows the completion of area
transferring hospital operations. reconnaissance and an estimate of the situation.
When time is available and the existing tactical
• Performing map, situation conditions prevent detailed planning
ground, and/or air reconnaissance of the routes, or area reconnaissance, the medical brigade or
and selecting the new site when possible. group prepares an initial march plan and issues
fragmentary orders (FRAGOs) to modify these
• Selecting routes. plans as needed. If conditions and time permit,
information in the OPORD includes—
• Designating start
points (SPs) and release points (RPs). • Destination and
• Reconnoitering the
route to the SP. • Rate of march, maxi-
mum speeds, and order of march.
• Providing for secu-
rity, maintenance, supply, and evacuation. • Start points and SP
• Determining the
march order (echelons), rate of march, maximum •
speed of vehicles, and distance between vehicles. Scheduled halts,
vehicle distances, and RPs.
• Establishing check-
points and halts. • Required communi-
• Establishing com-
munications security procedures. • Strip maps.
• Issuing strip maps. (Appendix I provides a sample OPORD with
annexes; FM 101-5 contains more detailed
• Dispatching recon- OPORD information.)
naissance and advanced parties.
(b) Each hospital division or
• Controlling traffic. section reports its supply, vehicle, equipment,
work load, and maintenance status to the
• Issuing orders. operations officer. This information is used in
coordination with higher headquarters to finalize
(2) Operation order. the convoy organization, compute additional
transportation and external support require-
(a) The operations officer has ments, and perform march computations. (For
staff responsibility for formulating, publishing, additional information on march computations,
and obtaining the commander’s approval of and see FM 55-30.)
(3) Area reconnaissance. operations officer and approved by the hospital
commander. It normally consists of representa-
(a) The medical brigade or tives from Echelon II of the convoy organization
group headquarters normally prescribes the (see paragraph 4-4c(2) above). It prepares the
reconnaissance route. The hospital operations new site for arrival of the main body. The
section uses a map reconnaissance in such cases advanced party performs duties to—
to confirm checkpoints, identify problem areas,
and begin planning positions of the CSH in the • Conduct a security sweep
new area. If the route is not prescribed and the of the new site to ensure the area is free of
CSH is not included as part of a reconnaissance enemy activity. This is normally done by security
party with other units, the operations section support forces.
briefs the reconnaissance team on the dis-
placement plan, provides the team with a strip • Position chemical alarms.
map and the designated MOPP level, and notifies
higher headquarters of the route selected. The • Establish communications
composition of the reconnaissance team is di- with higher headquarters and old location.
rected by the hospital commander.
• Designate boundaries of
(b) The reconnaissance party hospital elements based on unit defense plan and
wears the designated MOPP gear and monitors consistency with types of weapons and personnel
all radiological and chemical detection devices, availability.
It performs duties to—
• Increase security by man-
• Verify map informa- ning key points along the perimeter.
• Establish a command post.
• Note capabilities of
road networks. • Stake the hospital layout
(see TC 8-13).
• List significant ter-
rain features and potential problem areas. • Establish landline com-
munications for critical areas.
• Compute travel times
and distances. • Ensure personnel follow
dispersion and other measures.
• Perform route and
ground reconnaissance to include hospital site • Position personnel to
selection and layout. (See TC 8-13 for a detailed guide main body from the RP to designated
discussion on site selection, layout, and support locations.
(5) Main body. The main body
(4) Advanced party. The advanced moves as directed in the OPORD. The last
party moves before the main body and is dis- echelon normally closes out any remaining
patched as directed by the hospital commander, operations, ensuring the old site is clear of
Its composition is recommended by the medical evidence of intelligence valuable to the enemy,
and moves to the new site. This echelon includes • Prior to convoy op-
maintenance elements to deal with disabled erations, the commander designates the MOPP
vehicles. It also picks up guides and markers level.
along the route. As the main body arrives at the
new site, it is met by the advanced party and • The lead vehicle of
guided to designated positions. Erection of the each segment of the convoy has monitoring
hospital and the establishment of hospital capabilities and survey instruments, with a map
operations follows the priorities set by the indicating areas of contamination. The map
commander. includes data from the reconnaissance party
report. Continuous monitoring is conducted
(6) Crossing a nuclear, biological, through the contaminated area.
and/or chemical contaminated area. When the
hospital commander is directed by higher head- • Spacing of vehicles
quarters, or when the tactical situation dictates, should take into consideration dust generated by
the hospital may have to cross a contaminated the next forward vehicle.
area or an area designated as a contaminated • Disabled vehicles are
area. Should this situation occur, the following
are recommended procedures: abandoned after personnel are recovered with
notation of location.
(a) Operations section. (c) Decontamination.
• The operations of- • Immediately upon
ficer conducts a map reconnaissance of the area completion of the move, personnel and equipment
and briefs the commander on the best possible are decontaminated. The hospital is responsible
route. for decontaminating its personnel and equipment
(see FM 3-5). Decontamination beyond the capa-
• Based on the com- bility of the hospital will be requested from the
mander’s approval, a route reconnaissance is supporting chemical company.
conducted prior to moving the convoy through
the contaminated area. • The decontamina-
tion site is annotated on the map.
• The reconnaissance
team wears the appropriate MOPP level and (d) Reports. Upon completion
carries monitoring equipment. of the move, the operations officer reports
immediately to the hospital commander and
• The route selected higher headquarters any contamination acquired
should minimize hospital exposure when crossing during the move. Other required reports are also
the area. included.
(b) Convoy operations. 4-7. Emergency Displacement
• The convoy travels When confronted with an adverse tactical
at a maximum safe speed with no scheduled stops situation anchor when directed by higher head-
within the contaminated area. quarters, the CSH may be required to relocate
expeditiously. Movement procedures identified targets for the enemy’s NBC weapons. Although
above may be modified to accommodate the situa- the hospital may not be specifically targeted,
tion. As soon as the threat appears inevitable, all locating it close to other CS and CSS units, major
available means are used for evacuation of airfields, and road junctions makes it vulnerable
casualties, hospital personnel, and equipment. to NBC weapons. The hospital’s TEMPERs are
Wounded soldiers have priority on transporta- relatively permeable. Without increased protec-
tion assets. The critically wounded who cannot tion, hospital assets can be expected to experience
be moved are left behind with medical personnel, a significant amount of contamination and
supplies, and equipment. The decision to leave damage when exposed to NBC strikes. The
patients behind is made by the tactical distance of the CSH from other support units and
commander. Medical supplies and equipment are interposed terrain features as protective factors
not intentionally destroyed, even to prevent them must be balanced against accessibility and time
from falling into enemy hands. Paragraph 5 of required for patient transport. Prompt notifi-
Article 12, Geneva—Wounded and Sick (GWS), cation of, and reaction to, downwind messages in
provides that if we must abandon wounded or the event of NBC employment will enhance
sick, we have a moral obligation to, “as far as hospital operations and patient and individual
military considerations permit,” leave medical protective measures. However, NBC defense
supplies and personnel to assist in their care. includes all measures to minimize casualties and
enhance the effectiveness of hospital operations
under NBC conditions. These measures may be
4-8. Nuclear, Biological, and Chemical proactive or reactive in nature. They include
Operations contamination avoidance and control, protection,
and decontamination. For a comprehensive
As stated earlier in the threat, the corps’ and discussion on hospital operations in a NBC
division’s sustainment capabilities are prime environment, see FM 8-10-7 and FM 8-285.
TACTICAL STANDING OPERATING PROCEDURE
FOR HOSPITAL OPERATIONS
A-1. Tactical Standing Operating Proce- provide detailed information on major subdivi-
dure sions of the annex, and tabs can be used to provide
additional information (such as report formats or
This appendix provides a sample TSOP for a CSH. area layouts) addressed in the appendix.
It provides the tactics, techniques, and procedures
for hospital operations; however, it should not be b. Regardless of the format used, the
considered as all-inclusive. It may be supple- TSOP follows a logical sequence in the presen-
mented with information and procedures required tation of material. It should discuss the chain of
for operating within a specific command, con- command, major functions and staff sections of
tingency, or environment. the unit, operational requirements, required
reports, necessary coordination with higher and
subordinate elements for mission accomplish-
A-2. Purpose of the Tactical Standing ment, programs (such as command information,
Operating Procedure PVNTMED measures, and CSC), and other
The TSOP prescribes policy, guidance, and pro-
cedures for the routine tactical operations of a c. Pagination of the TSOP can be accom-
specific unit. It should cover broad areas of unit plished by starting with page 1 and numbering
operations and be sufficiently detailed to provide the remaining pages sequentially. If the TSOP is
newly assigned personnel the guidance required subdivided into sections, annexes, appendixes,
for them to perform their mission. A TSOP may and tabs, a numbering system that clearly
be modified by TSOPs and operation plans identifies the location of the page within the
(OPLANs)/OPORDs of higher headquarters. It document should be used. Annexes are identified
applies to a specific unit and all subordinate units by letters and are listed alphabetically. Appen-
assigned and attached. Should a TSOP not be in dixes are identified by numbers and arranged
conformity with the TSOP of the higher head- sequentially within a specific annex. Tabs are
quarters, the higher headquarters’ TSOP governs. identified by a letter and are listed alphabetically
The TSOP is periodically reviewed and updated within a specific appendix. After numbering the
annually. initial sections using the standard numbering
system (sequentially starting with page 1 through
to the end of the sections), number the annexes
A-3. Format for the Tactical Standing and their subdivisions. They are numbered as the
Operating Procedure letter of the annex, the number of the appendix,
the letter of the tab, and the page number. For
a. There is not a standard format for example, page 4 of Annex D is written as “D-4”;
all TSOPs; however, it is recommended that a page 2 of Appendix 3 to Annex D is written as
unit TSOP follow the format used by its higher “D-3-2”; page 5 of Tab A to Appendix 3 of Annex
headquarters. The TSOP can be divided into D is written as “D-3-A-5.” This system of num-
sections (specific functional areas or major bering makes the pages readily identifiable as to
operational areas). The TSOP may contain one their place within the document.
or more annexes, each of which may have one or
more appendixes. The appendixes may each have d. In addition to using a numbering
one or more tabs. Appendixes can be used to system to identify specific pages within the TSOP,
descriptive heading should be used on all pages a. The first section of the TSOP identi-
to identify the subordinate elements of the TSOP. fies the specific unit/headquarters that developed
(1) The first page of the TSOP
should be prepared on the unit’s letterhead. The (1) Scope. This paragraph estab-
remaining pages of the sections should include lishes and prescribes procedures to be followed
the unit identification in the upper right hand by the CSH and its assigned, attached, or opera-
corner of the paper (for example: "XXX Combat tional control (OPCON) units/elements.
(2) Purpose. This paragraph pro-
(2) A sample heading for an annex vides policy and guidance for routine tactical
is: “Annex Q (Nursing Service) to XXX Combat operations of the headquarters and its assigned,
Support Hospital.” attached, or OPCON units.
(3) Applicability. Except when
(3) A sample heading for an ap- modified by SOPs and OPLANs/OPORDs of
pendix to Annex Q is: “Appendix 4 (Patient Food higher headquarters, this paragraph applies to
Service) to Annex Q (Nursing Service) to XXX the hospital and to all units assigned, attached,
Combat Support Hospital.” or OPCON for combat operations. These orders,
however, do not replace judgment and common
(4) A sample heading for a tab to sense. In cases of nonconformity, the document
Appendix 4 to Annex Q is: “Tab C (Diet Roster) to of the higher headquarters governs. Each sub-
Appendix 4 (Patient Food Service) to Annex Q ordinate element will prepare a unit TSOP,
(Nursing Service) to XXX Combat Support conforming to the guidance herein.
(4) General information. This
e. As the TSOP is developed there may paragraph discusses the required state of
be an overlap of material from one annex to readiness of the unit; primary, secondary, and
another. This is due in part to similar functions contingency missions; procedures for operating
that are common to two or more staff sections. within another command’s AO; and procedures
Where overlaps occur, the material presented for resolution of conflicts with governing regu-
should not be contradictory. All discrepancies will lations, policies, and procedures.
be resolved prior to the authentication and
publication of the TSOP. The TSOP will be (5) References. This paragraph
authenticated by the hospital commander. can include any pertinent regulations, policy
letters, higher headquarters TSOP, or other
A-4. Sample Tactical Standing Operating b. The second section of the TSOP
Procedure (Sections) discusses the hospital organization.
The information contained in this paragraph can (1) Organization. The unit is
be supplemented. It is not intended to be an all- organized and equipped in accordance with the
inclusive listing. Different commands will have applicable MTOE an/or other staffing docu-
unique requirements that need to be included. mentation. The applicable MTOE and other
staffing documentation should be listed in this Applicable references, such as ARs, FMs, and
paragraph. TMs, should be provided in each annex. The
number of annexes and their subdivisions should
(2) Succession of command. The be based on command/contingency requirements.
guidance for determining the succession of Each annex should contain information relating
command is discussed. to mission, organization, duties and/or respon-
sibilities, and procedures. The following sample
(3) Task organization. Task or- annexes are provided as a guide and are not
ganization is contingent on the mission and will considered all-inclusive.
be approved by the headquarters ordering
deployment. a. Annex B, Hospital Headquarters.
This annex discusses the hospital commander and
(4) Organizational charts. Con- his responsibilities. The hospital commander is
tained in Annex A. the senior MC officer assigned or as appointed by
higher headquarters. The hospital commander,
c. The third section of the TSOP dis- assisted by the chiefs of surgery, nursing, and
cusses hospital functions. It will supplement the medicine, XO, chaplain, and CSM, provides the
hospital organizational chart(s). The functions of C2 necessary to accomplish the mission. The day-
the various hospital divisions/sections, to include to-day operations shall include a review of
personnel and some of their responsibilities, are hospital activities occurring during the pre-
provided in Chapter 2 of this publication. For a ceding shift and the implementation of directives
more detail description of personnel duties, see received from higher headquarters.
FM 101-5, AR 611-201, and AR 611-101.
(1) The daily assessment of hos-
d. The fourth section of the TSOP pital operations is accomplished via a report(s) on
pertains to division/section operations and is admissions, dispositions, bed census (by type),
subdivided into annexes. unusual occurrences, and significant seriously
ill patients. The chief of professional services
A-5. reports on bed availability by type bed and service
Sample Tactical Standing Operating capabilities that can be provided. This infor-
Procedure (Annexes) mation must also be provided daily to the PAD
Annexes are used to provide detailed information for medical evacuation and patient regulating
on a particular function or area of responsibility. operations.
The commander determines the level of specificity
required for the TSOP. Depending upon the (2) The commander and his staff,
complexity of the material to be presented, the in the conduct of daily operations, can use per-
annex may be further subdivided into appendixes sonal and telephonic contact to become aware of
and tabs. If the annex contains broad guidance personnel, logistical, and administrative problems
or does not provide formats for required reports, which may affect the overall hospital operations.
paragraphs may be used. The annex should not
require further subdivision. However, as the (3) Regularly scheduled meetings
material presented becomes more complex, and review of reports and programs can be used
prescribes formats, or contains graphic materials, to monitor the effectiveness and efficiency of
the annex will require additional subdivision. hospital operations.
(4) The hospital commander, dur- • Unit supply.
ing command visits or contacts with the medical
group, can be apprised of the tactical situation. • Duty rosters.
The hospital commander provides higher head-
quarters the hospital’s overall status to include • Physical fitness.
patient work load, hospital capability, personnel
status, logistical requirements, and other infor- • Training.
mation as he deems appropriate. The hospital
commander maintains liaison with the MEDLOG • Uniform Code of Military
battalion, medical evacuation battalion, MASH, Justice actions.
and corps support organizations.
c. Annex D, Tactical Operations Cen-
(5) The hospital commander may ter. Areas covered by this annex include—
activate the TOC based on the tactical situation.
(See Annex D for a discussion on TOC operations.) (1) Definition. The TOC is the
command element of the hospital containing
(6) This annex should also address communications and personnel required to
the hospital hours of operation, to include the command, control, and coordinate hospital and
hospital staff and personnel shifts. CHS operations.
b. Annex C, Company Headquarters. (2) Purpose. The purpose of the
This annex discusses the C2 structure for all TOC is to provide a secure area where the com-
assigned or attached officers and enlisted mander and key staff can assemble to estimate
personnel of the hospital. The annex outlines the situation, assess the requirements, and react
procedural guidance for, but not limited to, the to varying problems such as area defense, NBC
following: operations, mass casualty situations, and CHS
• Unit-level administration.
(3) Responsibilities. The hospital
• Reenlistment and extension commander has overall supervision and control
programs. over the TOC. The hospital XO has primary staff
responsibility in the absence of the commander.
• Billeting, to include fire safety, Daily operations of the TOC are the responsibility
sanitation, and key control. of the operations section.
• Security, assignment, account- (4) Operations. The TOC operates
ability, and maintenance of weapons. on a 24-hour basis. It is principally staffed by
each primary staff section. furnishing necessary
• Perimeter security. manpower as required. The TOC will be adjacent
to the communications facility, as well as in
• Life support and site improve- proximity to the emergency room and triage
ment. areas. The TOC should be of sufficient size to
allow for establishment of maps, storage of
• Welfare and recreational activi- individual weapons and chemical defense equip-
ties. ment, and facilitate communications among the
staff. Telephone communications connect the • Security requirements, to
TOC to other staff sections within the hospital, include guard duties and identification badges.
higher headquarters, and other appropriate units.
The CNR will also provide the appropriate • Briefing requirements.
communications for CHS. Access to the TOC is
strictly controlled by means of an access roster • Overlay preparation.
and, if available, security badges. Only essential
personnel and authorized visitors are allowed to (9) Camouflage. This paragraph
enter. Each hospital element maintains a TSOP discusses what camouflage procedures are re-
on the organization and operation of its section. quired, to include type and amount of required
All elements within the TOC maintain, when camouflage materials (such as nets and terrain
appropriate, a current situational map of their features); display of the Geneva Conventions dis-
specific operations. Discussion and portrayal of tinctive emblem on facilities and vehicles; and
tactical plans outside of the security area are other pertinent information. See FM 8-10 for
prohibited. information concerning the camouflaging of medi-
(5) Composition of the tactical
operations center. This is a listing of those d. Annex E, Operations. This annex
personnel comprising the TOC. It normally establishes procedures for the operations section
includes the commander, XO, CSM, principal staff within the hospital and provides a basis for stand-
members, and other specific staff members as ardization of CHS operations in a tactical
required. environment. It is essential that these procedures
be standardized to ensure common understand-
(6) Tactical operations center con- ing, facilitate control and responsiveness, and
figuration. This is a schematic representation of enhance mission accomplishment. Although in-
the physical layout of the TOC. It can be included telligence and hospital defense are functions of
as an appendix to the annex. the hospital operations section, they may be
addressed in separate annexes. For simplicity
(7) Message center. This para- and coherency, these areas are discussed in para-
graph establishes procedures for the handling of graphs e and f, respectively. Commanders may
classified messages; provides delivery and service elect to consolidate the S2/S3 functions into a
of IMMEDIATE and FLASH messages to the single annex. Appendixes to this annex should
appropriate staff section; and provides procedures include the following areas:
for preparing outgoing messages and delivery
service to the servicing message center for the (1) Operational situation report.
transmission of outgoing messages. Requirements for format, preparation, and
submission of this report are discussed in this
(8) Appendixes. The addition of appendix.
appendixes to this annex is permissible and may
cover topics such as— (2) Operations security. This
appendix provides the guidance and procedures
• Schematics of the physical for secure planning and conduct of combat
• Change of shift proce- (a) Responsibilities. The
dures. commander is ultimately responsible for denying
information to the enemy. The operations officer • Convoy operations (to
is responsible to the commander for the overall include clearance and security).
planning and execution of operations. He has
the principle staff interest in assuming the re- • Terrain analysis and site
quired degree of OPSEC and has the primary staff selection.
responsibility for coordinating the efforts of all
other staff elements in this regard. The opera- • Availability of required
tions officer is responsible for the preparation of support (engineer, communications, and supply).
the essential elements of friendly information
(EEFI) and for providing classification guidance. (4) Communications-electronics.
Additionally, the OPSEC officer identifies the pri- This appendix establishes communications
orities for OPSEC analysis and develops OPSEC policies, procedures, and responsibilities for the
countermeasures. Coordination is effected with installation, operation, and maintenance of
higher headquarters in planning an OPSEC communications-electronics (CE) equipment.
analysis of operations and analyzing EEFI. Responsibilities of the CE NCO include—
(b) Classified and sensitive • Advising the hospital
information. Document classification, down- commander and operations officer on CE matters.
grading, and declassification is the responsibility
of the operations section. Classified and sensitive • Determining requirements
information, such as the status of the forces, for communications support.
readiness condition, equipment status, and other
information relative to the hospital’s ability to •
perform its mission, will be limited to those Radio communications.
individuals with a security clearance and the need
to know. • Radio teletypewriter com-
(3) Hospital relocation. This ap-
pendix provides the procedures for hospital • Message and communica-
relocation. Because of the hospital’s limited tions center service.
mobility, transportation support and other site
preparation are required from COSCOM assets. • Message handling proce-
The operations officer, in conjunction with the dures.
supply and service division, plans and coordinates
hospital movement. Considerations should in- • Wire communications.
clude, but not be limited to, the following:
• Switchboard operations.
• Coordination with higher
headquarters. • Communications security
• Patient relocation. and operations.
• Tactical situation. • Security violations. This
prescribes procedures for reporting any event or
• Transportation require- action which may jeopardize communications
ments availability. security.
• Daily shift inventory. applicable estimates, analyses, periodic intel-
ligence reports, and intelligence summaries
• Physical security of com- generated within the hospital or received from
munications equipment. higher headquarters. Information on submission
of reports and suspenses on intelligence products
• Transmission security. and reports should also be addressed in this
• Security areas. This dis-
cusses access procedures and rosters, access (3) Counterintelligence.
approval requirements, and prohibited items.
• Camouflage. When ordered
• Communications security or directed by the tactical commander all units
officers and custodians. The appointment pro- will initiate and continually strive to improve
cedures, orders requirements, and duties of camouflage operations of positions, vehicles, and
personnel are described. equipment. Noise and light discipline is empha-
sized at all times.
• Safety. This discusses •
requirements for the grounding of, handling, and Communications security.
storage of COMSEC equipment. These measures are enforced at all times. Specific
requirements and considerations are included.
• Power units. • Signs and countersigns.
This paragraph outlines procedures for estab-
• Emergency destruction of lishing signs and countersigns to be used during
classified operating instructions and associated hours of darkness. It also includes reporting
materials. requirements and procedures if the sign/
countersign is lost or compromised.
e. Annex F, Intelligence and Security.
This annex pertains to intelligence require- • Document security. This
ments and procedures and operational security paragraph discusses the procedures for inven-
considerations. Appendixes to this annex may torying, marking, safeguarding, and destroying
include the following subjects: classified material, both work documents and
completed documents. Reporting requirements
(1) Intelligence. The operations in the event of compromise are also included.
section has the responsibility of collecting
information to assist the commander in reaching (4) Captured personnel, equip-
logical decisions as to the best courses of action to ment, supplies, and documents. This appendix
pursue. Essential elements of information (EEI) provides specific guidance on the handling of
include, but are not limited to, the location, type, captured personnel, equipment, supplies, and
and strength of the enemy threat; location of area documents. The disposition of captured medical
of casualty concentration; known or suspected equipment and supplies is governed by the
NBC activity; and issues which the commander Geneva Conventions and is protected against
considers to be EEI. intentional destruction.
(2) Intelligence reports. The opera- (5) Security. This appendix dis-
tions section is responsible for disseminating all cusses weapons security, SOI (communications)
security, TOC security, and Sensitive Item Status (1) Personnel loss estimate. Ini-
Report policies, guidance, or procedures. tially, FM 101-10-1/1 and FM 101-10-1/2 will be
used as a basis for the computation of gross and
f. Annex G, Hospital Defense. This special personnel loss estimates. Factors and loss
annex describes procedures for security of the rate tables in the FMs may not accurately reflect
hospital in a wartime environment. Security current situations and should be modified as
should be a part of an integrated defense plan actual experience factors are developed.
(base cluster commander and HN base defense
plan). Within the theater area, the base cluster (2) Emergency personnel replace-
and base commanders are appointed by the area ments. A request for hospital personnel replace-
commander. These commanders have the overall ment is submitted to the medical group S1 when
responsibility for the base cluster defense and there are unexpected losses for which no replace-
base defense organizations and plans. The ments are allocated.
hospital should be included as a part of the base
cluster/base plan as established by the base cluster/ (3) Personnel daily summary (PDS).
defense commander. This annex addresses, as a This paragraph provides the procedures for filling
minimum, the following: out and submitting a daily personnel status
report. The instructions may include require-
• Sustainment operations. ments for encrypting the report prior to
transmission, specific guidance on time of
• Defense reaction force(s). submission, corrections, or other administrative
• Hospital movement.
(4) Casualty reports. This para-
• Terrain management. graph applies to all US military personnel who
are serving within the hospital’s area of support
• Medical unit self-defense ac- and become casualties in areas under US control.
cording to the Law of Land Warfare (see Appendix It is also applicable to EPWs and civilian
G). For a comprehensive discussion on the Law internees who become casualties while under
of Land Warfare, see FM 8-10 and FM 27-10. control of US units.
g. Annex H, Administration and Per- • Casualty feeder report.
sonnel. This annex outlines procedures relating This report is submitted on DA Form 1156.
to administrative and personnel matters and Instructions on the completion of the form and
associated activities. The theater surgeon has submission requirements are included.
assignment, reassignment, and career man-
agement authority for all AMEDD officer and WO • Witness statements on
personnel arriving into or within the theater individuals (DA Form 1155). This statement is
during mobilization and wartime. Request for completed only when the recovery of a body is not
personnel and administrative support will be possible, or cannot be identified. It is to be
submitted through the medical group (S1 submitted to the S1 within 24 hours of the
[Adjutant, U.S. Army]) to the appropriate sup- incident. The paragraph should contain infor-
porting regional personnel center. Paragraphs of mation on obtaining the form, instructions for
the annex or attached appendixes should discuss completing it, and other relevant information or
the following: procedures.
• This section may also • Correspondence. All cor-
include other reports required by the command. respondence addressed to higher headquarters is
submitted through the administrative division.
(5) Personnel management. Requirements for submission, preparation, and
approval are also provided.
• Replacements. Individual
replacements will not be readily available during • Personnel records. This
the initial phases of operations. The adminis- paragraph discusses requirements for coor-
trative division will automatically initiate dination of this support. It also discusses the
replacement requests for personnel who are procedures for having correspondence included
reported on the PDS report as wounded in action, in the official military personnel records of
missing in action, or killed in action. personnel assigned and attached.
• Assignments and reas- (6) Personnel services. Personnel
signments. This paragraph will address the services are those activities pertaining to soldiers
actions required for patients and permanent party as individuals. Unless prohibited by the tactical
personnel. situation, the services listed below will be
available to all assigned and attached units.
• Leaves. Ordinary and
emergency leave procedures are outlined in AR • Sporting activities and
630-5. Policies established by the theater will morale and welfare activities.
take precedence. • American Red Cross.
• Personnel actions. All • Finance. This service
personnel actions are channeled through the includes disbursements and currency control,
administrative division. Division/section chiefs payday activities, currency conversion, check
and NCOICs are the hospital points of contact. cashing, and the appointment of Class A agents.
Actions will be handled expeditiously and meet
suspense dates (tactical situation permitting). • Legal services. Informa-
tion and specific guidance on administrative
• Efficiency reports. This boards, courtmartial authority and jurisdiction,
paragraph describes the pertinent information legal assistance, and general services should be
needed for the completion and submission of these provided.
• Religious activities. Reli-
• Award recommendations. gious activities include chaplain support, services
This paragraph delineates the responsibilities and available for different faiths, schedule of services,
guidance for submitting recommendations for and hospital visitations.
awards and for scheduling and conducting award
ceremonies. • Postal services. This in-
cludes hours of operation and services available.
• Promotions. This para- Emergency destruction, prisoner of war mail, and
graph discusses the procedures for submitting mail restriction policies will be outlined. Postal
recommendations for promotion and for sched- services should be addressed in an appendix to
uling and conducting promotion ceremonies. this annex.
• Post exchange services. clothing), procedures, and marking and reporting
This includes hours of operation and availability. of burial site.
• Distribution. Pick up and (8) Public information. This ap-
delivery schedules and any command-specific pendix contains procedures for obtaining approval
issues and procedures are provided. on the public release of information to include
the hometown news release programs.
(7) Mortuary affairs. Commanders
at all levels are responsible for unit MA and the (9) Maintenance of law, order,
search, recovery, and evacuation of remains to and discipline. This appendix should provide
collection points. Selected hospital personnel applicable regulations, policy, and command
should be trained on MA tasks to ensure proper guidance on topics such as serious incident
handling of remains and the deceased’s personal reports, notifications and submission formats,
effects. straggler control, confinement of military
prisoners, and EPWs (also discussed in (10)
• Responsibilities. This below).
paragraph discusses hospital responsibilities and
the relationship with the medical group and
supporting MA activity. (10) Enemy prisoners of war. This
appendix discusses the unit responsibility for
• Disposition. Specific guid- EPWs captured by or surrendered to the unit.
ance on procedures, MA collection points, These procedures do not pertain to EPW patients
transportation requirements, and handling of captured by other units. Medical personnel do
remains is provided. not guard, search, or interrogate EPWs while in
the CHS system; guards are provided by
• Hasty burials. Specific nonmedical personnel designated by the tactical
requirements for conducting hasty burials and commander for these duties. Until EPW per-
marking and reporting of grave sites are included. sonnel can be evacuated to an EPW collection
point, medical personnel should remember and
• Personal effects. Guid- enforce the basic skills: segregate, safeguard,
ance on accounting for personal effects and silence, secure, speed, and tag. (The speed portion
requirements for burial should a hasty burial be of evacuating EPWs to designated collection
required is contained in this paragraph. points is of paramount importance to medical
• Disposition of civilian and
EPW remains. The local civilian government is
responsible for the burial of remains of its citizens. NOTE
The remains of EPWs are buried in separate
cemeteries from US and allied personnel. If this The treatment of EPWs is governed by
is not possible, a separate section of the same international and US law and the
cemetery is used and will be properly marked. provisions of the Geneva Conventions.
Personnel should be aware of these
• Contaminated remains. requirements and have ready access to
This paragraph discusses handling and dis- the applicable regulations and policy
position requirements (to include protective guidance (see FM 8-10 and AR 190-8).
(11) Records disposal procedures. • Burial services.
The emergency disposal of files, when hostile
action is imminent and if retention is prejudicial • Reports.
to the interest of the US, will be outlined.
Nonemergency disposal, to include lost or (2) Chaplain funds. Procedures
destroyed files, will be included. will be outline for the establishment of a non-
appropriated chaplain’s fund upon mobilization.
(12) Appendixes. The following
appendixes should be developed as part of this i. Annex J, Nuclear, Biological, and
annex: Chemical Defense. This annex provides general
guidance regarding unit and individual defense
• Human relations and against NBC attacks, decontamination proce-
equal opportunity. dures, and care of NBC casualties.
• (1) The NBC NCO is the technical
Civilian personnel. advisor to the hospital commander and the opera-
tions officer on all matters pertaining to NBC
• Provost marshal. operations. Procedures should be developed for—
• Safety (see Appendix D). • Organizing and training
the required NBC teams.
• Postal operations.
• Establishing a warning
• Command message center. and alarm system. The system will include vocal,
visual, and sound.
h. Annex I, Chaplain. This annex out-
lines the duties and responsibilities of the hospital • Training hospital person-
chaplain and the hospital ministry team. nel on MOPP and other NBC defensive measures.
Although the chaplain reports directly to the
hospital commander, his activities will be • Advising the hospital com-
coordinated with the hospital adjutant. mander on activation of the appropriate MOPP
level, to include masking and unmasking
(1) Chaplain support and cover- procedures, based on the tactical situation.
age. This paragraph will address the following: • Maintaining NBC records
• and submitting the required reports.
Normal and emergency
chaplain duties. • Establishing collective shel-
ters. The operations section will determine the
• Religious services. requirements for NBC collective shelters, The re-
sponsibility for establishing and maintaining
• Visitation. NBC shelters rest with the section being
• The seriously ill.
• Publishing radiation ex-
• Death. posure guidance. This includes methods to
minimize exposure and protect against electro- • Appendix 12—References.
j. Annex K, Nutrition Care. This
• Maintaining and distrib- annex outlines procedures relating to patient
uting unit NBC defense equipment. nutrition management and Army medical field
feeding operations. The annex addresses the
• Maintaining account- nutrition care division’s organization and staff
ability and proper stockage of NBC defense responsibilities. The organization and a detailed
equipment and PLL items. discussion of the following specific areas should
be included as appendixes:
(2) This annex should include the
following appendixes: • Organization.
• Appendix l—NBC Teams. • Medical rations.
• Appendix 2—Decontami- • Patient meal delivery.
• Appendix 3—Operating in • Staff and ambulatory patient
an NBC Environment. feeding.
• Appendix 4—Individual • Safety.
and Collective Protective Plan.
• Appendix 5—Handling
and Patient Care of NBC Patients. • Nutritional support.
• Appendix 6—Handling • Nourishments, to include
Contaminated Patients. forced fluids.
• Appendix 7—Establishing • Ration accountability.
• Ration procurement.
• Appendix 8—Locating
Contaminated Areas (to include traffic control in • Equipment maintenance.
and out of the area).
• Appendix 9—NBC Re- • Training.
• Appendix 10—Hospital
Recovery. k. Annex L, Logistics. This annex out-
lines sources, procedures, requirements, respon-
• Appendix 11-Radiation sibilities, and planning guidance for logistical
Exposure Guidance. support for a CSH.
(1) Specific areas which are ad- (2) Transportation and movement
dressed are listed below. The discussion to the requirements. This appendix covers the following
areas should be provided in appendixes with the areas: applicability; responsibilities; policies on
inclusion of tabs, if appropriate. speed, vehicle markings, transporting flam-
mable materials, transporting ammunition and
• Supply and services. weapons, convoy procedures; safety; and accident
• Medical supply.
(3) Fire prevention and protection.
• General supply. Guidance on the use of flammable materials, use
of cigarettes, matches, and lighters, electrical
wiring and appliances, safety of tents and
• Maintenance (less medi- occupants, spacing of tents, stoves and ranges,
cal). and firefighting equipment are presented in this
• Medical equipment main-
tenance. (4) Field hygiene and sanitation.
This appendix provides uniform guidance and
• Waste disposal. procedures for the performance of functions
related to field hygiene and sanitation. It includes
• Linen. policies, communicable disease control, field water
supply, water trailers and cans, fabric water
• Interface with the storage containers, food sanitation, latrines, liquid
MEDLOG battalion (forward). waste disposal, and garbage and rubbish disposal.
For additional information on field hygiene and
• Transportation and mo- sanitation, see FMs 21-10 and 21-10-1.
(5) Conventional ammunition down/
• Supply and distribution. upload procedures. This appendix delineates
responsibilities; provides guidance and proce-
• Engineer support. dures for the requisition, storage, and distribution
of ammunition and weapons, reporting require-
ments, arid safety.
• Quartermaster support.
(6) Petroleum, oils, and lubricants
• Hospital safety. accounting.
• Blood component resup- (7) Health service logistics sup-
ply. port. The health service logistics concept of
operations, requisition, and distribution proce-
Logistics applications of automated marking dures, accountability, and reports are provided
and reading symbols (LOGMARS), TACCS, in this appendix.
MEDTCU, and test, measurement, and diagnostic
equipment are included in the discussions when 1. Annex M, Laboratory. This annex
appropriate. prescribes laboratory policies and procedures in
support of the hospital. Procedural guidance will • Performing blood gas
include, but not be limited to— analysis.
• Hematology and urinalysis. • Performing electrolyte
levels (Na, K, Cl, and C02).
• Performing white cell
count. • Determining total serum
• Performing complete
blood count (red blood cell [RBC], white blood • Determining serum pre-
cell [WBC], hemoglobin [Hgb], and hematocrit atinine.
• Determining serum am-
• Determining Hct. ylase.
• Determining WBC dif- • Determining serum AST
• Determining prothrombin • Determining serum ALT
• Determining partial • Determining serum CK
thromboplastin time (APTT). activity.
• Performing cerebrospinal • Determining serum glu-
fluid (CSF) cell count and differential. cose.
• Performing urinalysis • Determining serum T.
• Performing urinalysis • Determining serum cal-
• Performing platelet esti- • Determining CSF glucose.
• Determining CSF protein.
• Performing platelet count.
• Determining urine protein.
• Determining fibrinogen
level. • Determining urine glucose.
• Determining fibrin degra- • Microbiology and serology.
• Performing occult blood
• Biochemistry. test.
• Performing thick and thin m. Annex N, Blood Bank Services. This
smears for malaria. annex prescribes hospital blood bank policies and
procedures. It addresses procedures for—
• Performing gram stains.
• Storing, collecting, and admin-
• Performing RPR test istering blood and blood products.
• Performing blood group and
• Performing IM (infectious type (ABO, RH).
mononucleosis) tests. • Performing abbreviated blood
• crossmatching procedures.
Examining feces for ova,
cysts, and parasites. • Thaw and issue fresh frozen
• Performing potassium
hydroxide (KOH) preps. • Blood planning factors.
• Performing pregnancy • Reports.
• Automated blood management
• Microbiology (capabilities avail- system.
able with specific augmentation).
n. Annex O, Dental Services. This
• Performing urine cultures annex outlines policies and procedures for dental
(colony counts and sensitivity). clinic operations in a CSH. Procedures include—
• Performing wound cul- • Priority of treatment.
ture and sensitivity.
• Dental records.
• Performing culture and
sensitivity for gonorrhea. • Narcotics and drug control.
• • Dental supply and mainte-
Performing throat cul- nance operations.
• Precious metal control.
• Quality control procedures.
• Mercury hygiene and syringe
• Reports. and needle security.
• Infectious, chemical, hazard- • Sterilization and infection con-
ous, and solid waste disposal. trol.
• Safety. • Safety.
o. Annex P, Pharmacy Service. The • Claims.
pharmacy operation is centered around an in-
patient and outpatient system, distribution of • Processing hospital deaths.
bulk drugs, and the IV-additive program. This
annex addresses the following procedures: • Theater Army Medical Man-
agement Information System MEDPAR and
• Storing, safeguarding, labeling, MEDREG.
and dispensing pharmaceutical and drug pro-
ducts. q. Annex R, Nursing Service. This
annex provides administrative and operational
• Operating an IV-additive pro- guidance for all nursing service personnel
gram. throughout the hospital. It provides nursing care
standards, policies, and procedures which are
• Controlling drugs (Q and R). applicable to all wards, to include ORs and the
triage, EMT, and preoperative treatment sections.
• Preparing signature cards. Areas addressed should include, but not be
limited to, the following:
• Accessing letters.
• Nursing documentation.
• Rotating stockage of drugs and
medication. • Scope of nursing practices.
• Requisitioning drugs and sup- • Standards of nursing practice.
• Standards of patient care.
• Preparing reports.
• Assignment of personnel.
p. Annex Q, Patient Administration •
Division. This annex outlines the general func- Infection control.
tions for the PAD. Procedural guidance is
identified for the following: • Special category patients.
• Maintenance and account- • Procedures available in radi-
ability for clinical records. ology.
• Admittance, discharge, and • Procedures available in labora-
transfer of patients (surface and air movement). tory.
• Processing and disposition of • Admission and discharge.
weapons, ammunition, maps, and classified and
sensitive documents taken from patients admitted • Procedures for cardiopulmo-
to the hospital. nary resuscitation.
• Medical statistics and reports. • Mass casualty plan.
• Preoperative care of the (2) Appendixes to the annex may
patient. include other information to assist daily
operations. Suggested areas are—
• Postoperative care of the
patient. • Radiation safety.
• Care of patient with indwelling • Radiation protection.
• Equipment records.
• Care of patient with central IV
lines. • Radiographic film security.
• Care of patient with trache- • Filing procedures.
s. Annex T, Medical Services. This
• Care of patient with chest tube. annex prescribes the duties and procedures for
medical services in the treatment of all patients
• Death procedures. admitted to the hospital. Areas to be addressed
include, but are not limited to—
• Hazardous and medical waste
disposal. • Treatment protocols.
• Bedpan and urinal washing • Examination procedures.
and disinfecting procedures.
• Evaluation and treatment of
r. Annex S, Radiological Services. infectious diseases.
This annex establishes policies and procedures
for requesting radiological services, preparation • Evaluation and treatment of
of patients, and use of x-ray films. internal medicine disorders.
(1) Request for diagnostic proce- • Evaluation and treatment of
dures is outlined for the following examinations: skin disorders.
• Routine. • Treatment of patients with
• Emergency. gynecological diseases, injuries, or disorders.
• Bedside. • Medical supply and resupply
• Special (upper gastroin-
testinal series, gallbladder). • Consultation services.
• Urological. • Infection control (procedures to
be followed to reduce the threat of infection in an
• Preoperative chest x-rays. austere environment).
• Fire evacuation plan. • Transportation of patients
to and from the OR.
• Transportation of sterile,
t. Annex U, Surgical Services. This clean, and dirty equipment.
annex outlines diagnostic and surgical treatment •
procedures for the hospital. It should include, Evacuation of personnel
but not be limited to, the following: and patients during contingencies.
• Handling contaminated needles
• Scheduling procedures, to in- and syringes.
clude after-hours and emergency cases.
• u. Annex V, Operating Room/Central
Aseptic (sterile) techniques. Materiel Service Control Team. This annex
outlines the functional procedures of the OR,
• Maintenance of registry. CMS, and anesthesia services, and the
preparation and maintenance of OR-related
• Scrub attire and surgical hand- equipment. With exception of CMS, the OR and
scrub procedures. anesthetists are not a separate paragraph in the
L-edition series TOE. As an entity, these
• Environmental safety. elements are under the supervision of the senior
anesthesiologist or the officer appointed by the
• Electrosurgical unit safety. hospital commander. The operational guidance
includes, but is not limited to—
• Operating room environmental
sanitation. (1) Operating room service.
• Counts of sponges and sharps. • Verifying personnel quali-
fications for assigned duties.
• Bullet removal evidence and
• Scheduling nursing staff.
property custody document.
• Providing immediate post-
• Death procedures. operative care of surgical patients (recovery room/
• Availability of ORs.
• Autopsy, to include coor-
dination with HN health officials or compliance • Operating room space uti-
with valid agreements. lization.
• Disposition. • Medical resupply, to in-
clude time lines.
• Cardiac arrest procedures.
• Medical maintenance, to
• Traffic patterns. include organic and depot.
(2) Anesthesia services. v. Annex W, Emergency Medical Ser-
vices. This annex outlines the procedures for
• Standards. receiving patients, performing patient assess-
ments, providing EMT, and transporting patients
• Duty roster and on-call to the appropriate element of the hospital.
requirements. Procedures include—
• Master list of clinical pro- • Continuous 24-hour emergency
cedures. treatment service.
• Equipment checklists. • Verification of personnel quali-
• Classification of patients. fication.
• Narcotics control. • A 24-hour physician and
nursing service coverage plan.
• Infection control in work
area. • Patient registration ledger.
• Anesthesia carts. • Triage.
• Disposition of hazardous • Scope of practice of MOS 91B
or infectious waste. personnel.
• Storage of combustibles • Routine patient care manage-
and cleaning schedule. ment.
• Quality control proce-
dures for equipment. • Emergency patient care man-
• Verifying personnel quali-
fications for assigned duties. • Care of HIV military and de-
pendents (as required).
(3) Central materiel service.
• Care of HN contract civilian
• Loading and unloading and other HN medical care requirements.
the steam sterilizer.
• Admission and transfer of
• Monitoring the steriliza- patients.
• • Mass casualty operations.
Labeling and monitoring
shelf life of sterile items. • Medical treatment for chemical
• Providing tray setup and and biological agent patients.
wrapping procedures, to include cleaning and pre-
paring equipment and supplies for sterilization. • Medical evacuation.
• Utilization of the hospital litter • Stress control to patients and
team. staff of other wards.
• Medical resupply and mainte- x. Annex Y, Physical Therapy. This
nance. annex outlines procedures for the utilization and
support of physical therapy services. Areas to be
• Care of refugees and displaced addressed include, but are not limited to, the
• Assessment and emergency • Verification of personnel qual-
treatment of patients undergoing and awaiting ification.
• Scope of practice of physical
w. Annex X, Neuropsychiatric Service therapy personnel.
and Ward. This annex outlines procedures for
hospital NP service including diagnosis and • Assignment of physical therapy
consultation to all areas within the hospital and personnel.
to others as may be directed by the command.
Procedures include, but are not limited to— • Services provided.
• Screening of patients by a
psychiatrist. • Referral procedures.
• Ward support for nonambula- • Mass casualty role.
tory or secluded patients.
• Utilization of radiology and
• Patient ledger and transfer pharmacy services.
• Injury prevention programs.
• Patient restraining.
• Logistical support.
• Enemy prisoner of war patient
support augmentation. y. Annex Z, Mass Casualty. This an-
• Records and administration. nex outlines procedures to enable the hospital to
respond effectively to a variety of emergency,
• Drug control. external, and internal disaster situations. In any
situation, the hospital must be prepared to re-
• Identifying and monitoring ceive, triage, treat, and hospitalize large numbers
suicidal and homicidal patients. of casualties within a short period of time. The
development of this plan is the responsibility of
• Neuropsychiatric and combat the operations section, or as directed by the hos-
fatigue-related casualties. pital commander. Procedures include—
• Medical supplies and mainte- • Planning and training require-
• Medical cadre positions. • Discharge of patients.
• Nonmedical personnel posi- • Records and reports.
tions and duties, including litter teams, perimeter
guard, crowd control, and information personnel. z. Annex AA, Civil-Military Opera-
tions. This annex discusses participation in civil-
• military operations (CMO). Medical elements are
Location of services, to include often involved in CMO, humanitarian assistance,
triage, delayed care, immediate care, minimal and disaster relief operations. The activities
care, and expectant care areas. which may be covered include providing medical
treatment within the capabilities of the hospital
• Support requirements beyond and providing training to a HN’s medical
hospital capability. infrastructure. The responsibility for this annex
is the operations officer, or as directed by the
• Evacuation. hospital commander.
HOSPITAL PLANNING FACTORS
This appendix provides information for the hospital commander, his staff, and assigned personnel. It
contains planning factors for personnel, transportation and movement, supply, personnel service
support, CHS planning for hospitalization, engineer, and force requirements as of 1 January 1993. The
data is an estimate and is not intended to be all inclusive. Fluctuations and changes in the data
presented are contingent upon modifications to the TOE, its mission, and the scenario. The data is
based upon TOE 08-705L00, Medical Force 2000 Hospital Planning Factors prepared by the Directorate
of Combat and Doctrine Development, Army Medical Department Center and School; FM 101-10-1/2
(Staff Officers’ Field Manual—Organizational, Technical, and Logistical Data Planning Factors, Volume
2); and mobilization planning factors obtained from the US Air Force (USAF).
B-2. Personnel and Equipment Deployable Planning Factors
b. Weight and Cube—Personnel and Equipment.
Personnel-weight (combat equipped,
includes 15 lb hand-carry bag) 190 lb/man (303) 57,570 lbs
Personnel-weight (with M-16) 200 lb/man (275) 55,000 lbs
Personnel-weight (with 9 MM) 195 lb/man (26) 5,070 lbs
Personnel-cube 11 cu ft/man 6,644 cu ft
Mobilization bag-weight 25 lb/man 15,100 lbs
Mobilization bag-cube 1 cu ft/man 604 cu ft
Check-in baggage-weight 70 lb/man 42,280 lbs
Check-in baggage-cube 3 cu ft/man 1,812 cu ft
Personnel-weight and cube with all gear 175,020 lbs 9,060 cu ft
Weight and cube TOE equipment 1,373,943 lbs 339,175 cu ft
Weight and cube, common table of
allowances (CTA) deployable
equipment 245,763 lbs 25,296 cu ft
Weight and cube of personnel, TOE
equipment and CTA deployable
equipment 1,794,726 lbs 373,531 cu ft
c. Transportation Reference Data.
(1) Semitrailer requirements.
M871 semitrailer, platform, break-bulk,
container transporter, 22½ ton,
length = 29.8 ft; width = 8 ft,
height = 4.6 ft 30 each
(2) Railcar transportation requirements.
Railcar = 80 ft 38 each
(3) Tactical aircraft airlift requirements.
Cargo compartment data: C-141 vs C-5A
Length (inches) 840 1,454
Width (inches) 123 228
Height (inches) 109 162
Allowable cargo load (lbs) 50,000 150,000
Troop Seats 102 20/73
Aircraft Requirement 15 11
(4) Commercial cargo capacities and configurations.
Cargo Bulk Number Maximum Capacity
Capacity Bin of Cargo Bins Cargo Door Sizes
(cu ft) (cu ft) Containers (lbs) (inches)
2,385 700 16 (LD-3) 53,650 FWD 70W 68H
AFT 70W 68H
2,831 435 19 (LD-3) 61,500 FWD 104W 68H
AFT 70W 68H
Cargo Bulk Number Maximum Capacity
Capacity Bin of Cargo Bins Cargo Door Sizes
(cu ft) (cu ft) Containers (lbs) (inches)
2,508 430 22 (LD-2) 46,050 FWD 70W 69H
AFT 70W 69H
4,770 430 30 (LD-2) 69,850 FWD 70W 69H
AFT 70W 69H
1,728 25,700 FWD 55W 42H
AFT 55W 44H
1,454 19,000 FWD 55W 42H
AFT 55W 44H
1,253 21,855 Three cargo bin doors
850 12,985 FWD 48W 34H
AFT 48W 35H
1,068 12,634 FWD 48W 34H
AFT 48W 35H
750 11,150 FWD 53W 31H
AFT 36W 30H
(5) Sealift planning factors.
Ship Type Square Foot Capacity
Fast-sealift ship 150,000 sq ft
Roll-on/roll-off 100,000 sq ft
Break-bulk 40,000 sq ft
Container ship 600 containers
B-3. Hospital Operational Space Requirements
It is estimated that the hospital will require an area approximately 350 meters X 350 meters for its full
complement of personnel and equipment.
B-4. Logistics Planning Factors (Class I, II, III, IV, VI, VIII)
a. Classes of Supply Planning Factor Rates.
(1) Planning factor rates.
Class I A Ration 2.410 lbs/meal
B Ration 1.278 lbs/meal
T Ration 2.575 lbs/meal
MRE 1.470 lbs/meal
Medical B Ration 1.393 lbs/meal
RSSP 0.410 PMD
LRPP 0.900 PMD
FHC 0.030 PMD
Class II 3.670 PMD
Class III (Packaged) 0.590 PMD
Class IV 8.500 PMD
Class VI 2.060 PMD (Temperate)
3.400 PMD (Tropic/Arid)
1.790 PMD (Arctic)
Class VIII 1.550 PMD
Legend: MRE Meal(s), Ready to Eat
RSSP Ration Supplement Sundries Pack
LRPP Long-Range Patrol Pack
FHC Female Health and Comfort Items
PMD Pounds Per Man Per Day
(2) Class VI requirements (personal demand items).
Departments Arid/Tropic Temperate Arctic
Tobacco Products 0.055 0.055 0.055
Snacks 0.455 0.455 0.455
Beverage 2.800 1.467 1.186
Personal Hygiene 0.047 0.047 0.047
General 0.048 0.048 0.048
TOTAL (lbs/man/day by climate) 3.395 2.058 1.791
Female health and comfort packets are made available in a TO for issue, pending establishment of
adequate exchange facilities. A packet weight is not available, but planners can use an estimated factor
of 0.03 lbs/person/day based on the FHC items listed in AR 700-23.
(3) Female health and comfort items.
Item Number Item Description Unit of Issue Allowance
1 Cream, Cleansing, 2 oz Tube 25
2 Lotion, Hand/Body, 2 oz Tube 40
3 Napkin, Sanitary, 12S Box 25
4 Paper, Toilet, 24 Sheets Package 500
5 Tampon, Sanitary, 12S Box 25
6 Tissue, Cleansing, 12S Package 250
(1 Pack/25 Females/30 Days)—Federal Stock Number 8970-01-185-2590
b. Class I Subsistence. Description of rations and packets.
(1) A Rations consist of both perishable and semiperishable food. It is intended for use
primarily under stable conditions and during static phases of military operations when normal cooking
and refrigeration are available.
A Ration Planning Factors
Percent of Per Man Per 100 Men Per 1,000 Men
Factor Total Weight Per Day Per Day Per Day
Average weight 100 7.23 723 7,230
Semiperishable 35 2.56 256 2,560
Perishable 65 4.67 467 4,670
Chill 48 3.50 350 3,500
Freeze 16 1.18 118 1,180
Ventilated 9 0.67 67 670
(2) B Rations consist of approximately 100 semiperishable items, mainly canned and
dehydrated, and are supplied in bulk. B Rations are used when there are kitchen facilities but no
Standard B Ration Planning Factors
Per Man Per 100 Per 1,000
Factor Per Day Men Men
Net Regular Menu Items 3.198 319.80 3,198.0
(Pounds) Alternate Menu Items 3.683 368.30 3,683.0
Gross Regular Menu Items 3.834 383.40 3,834.0
Pounds) Alternate Menu Items 4.368 436.80 4,368.0
Gross Regular Menu Items 0.1226 12.62 122.6
(Cubic Feet) Alternate Menu Items 0.1200 12.00 120.0
(3) The MRE is designed for use as individual meal packets, or in multiple of three for a
complete ration. This packet is not to be used for extended periods. It comes in a pouch that can be torn
open. Heating of meat components is desirable. Twelve different menus are available.
(4) The MRE is not authorized as the sole ration source for a period in excess of 10 days
per guidance from the current Surgeon General. They are not authorized for patient use at any level
within the theater medical system unless it is the only ration available because the effect on immobilized,
traumatized patients is unknown.
(5) T Ration is a ready-to-heat and serve tray pack. It is used under conditions when
kitchen facilities and normal refrigeration do not exist. The container package is designed for immersion
heating in boiling water. Included are disposable eating utensils. There are a total of 28 T Rations
menus; 10 breakfasts with 4 alternates, and 10 dinners with 4 alternates. T Rations are not authorized
for feeding hospitalized patients except in emergencies when other rations are not available.
(6) Ration supplement sundries pack is composed of items necessary to the health and
comfort of troops such as essential toilet articles, tobacco, and confections that are usually obtained at
an exchange. This packet is made available in a TO for issue, pending establishment of adequate
service facilities. (See AR 700-23.) National Stock Number (NSN): 8970-00-268-9934.
c. Planning Guidance for Operational Rations.
Time Rations Served Daily Guidance
D—D-1O 3 MRE Order pouch bread, and flameless ration heater
D-11—D-30 2 MRE, 1 T Ration Augment with milk, fresh fruit, vegetables, and
D-31—D-90 1 MRE, 2 T Rations Augment with milk, fresh fruit, vegetables, and
d. Characteristics of Rations and Subsistence Items.
Net Weight Volume Cases
Item Contents (Pounds) (Cubic Feet) Per Pallet
Standard B Ration 300 Meals 319.8 12.26
Regular Menu (100 men
MRE 12 meals 17 0.83 48
Unitized Tray Pack 36 trays 80--90 2.67
LRP Food Packets 40 packets 36 1.84 24
Ration Supplement 1 packet 41 1.67 24
Sundries Pack (100 men
NSN 8970-00-268-9934 per day)
Ration Supplement 2 packs 22 0.99
Beverage Pack serve 200
NSN 8970-01-108-2858 men
Ration Supplement 1 packet 16 1.01 39
Aid Station (100 8-OZ
NSN 8970-00-128-6404 drinks)
General-Purpose 24 packets 20 0.43 90
Food Survival Packet
e. Army Medical Field Feeding Policy. The medical Army feeding policy for hospitalized
patients is three hot meals daily. The meals will consist of Medical B Rations. A Ration meals or
components will be used when the tactical and logistical situation permits. Meals, ready to eat and
T Rations are NOT AUTHORIZED for feeding hospitalized patients EXCEPT IN EMERGENCIES
when other rations are not available.
f. Army Medical Field Feeding Inpatient Census and Accounting.
(1) Inpatient census is obtained from the Recapitulation Table of the Admissions and
Disposition Report, which is prepared daily by the hospital PAD. Inpatient figures reflect the number of
hospital beds occupied as of 2400 hours of the previous day.
(2) Inpatient (accounting) strength will be recorded in the Remarks Section of the DA
Form 5913-R (Strength and Feeder Report) for information purposes. Patient strength will not be
included in the present-for-duty section of DA Form 5913-R.
g. Standard Medical B Ration Purpose/Policy.
(1) Standard Medical B Ration is planned for subsisting patients in Armed Forces MTFs
when semiperishable food is required.
(2) Patients are exempt from the theater ration policy and will receive three hot prepared
meals per day.
(3) Staff assigned to medical units will be fed according to the service theater ration
policy. To simplify procurement, menu preparation, and service when hot meals are served to medical
personnel, they will be served the regular diet from the Medical B Ration.
(4) In unusual circumstances (for example, facility relocation/movement), operational
rations may be required for staff (not to exceed ten days).
h. Standard Medical B Ration Meals.
(1) To support 24-hour patient care, the hospital must prepare four meals per day:
breakfast, lunch, dinner, and a night meal. The night meal may utilize a breakfast or lunch/dinner
menu according to local procedures.
(2) Patients requiring late meals will be served as complete a meal as possible with items
from the preceding meal.
(3) Late meals will be served in accordance with dietary constraints, local procedures,
and PVNTMED sanitation guidelines.
i. B Ration Weight and Cubage.
Net Weight of Ration 3.0857 lbs
Gross Weight of Ration 3.6390 lbs
Gross Cube of Ration 0.1173 cu ft
j. Estimated Combat Support Hospital Logistics Planning Factors (Class I, II, IV, VI, and
Class Lbs/Man/Day Lbs/Unit/Day STONS/Unit Day
I Subsistence 4.47 2,699.88 1.35
II Supplies 3.67 2,216.68 1.11
IV Barrier 4.00 2,416.00 1.21
0.00 2,727.00 1.36
VI Personal 2.06 1,244.24 0.62
VIII Medical 1.55 936.20 0.47
TOTAL 12,240.00 6.07
k. Planning Combat Support Hospital Blood Requirements.
(1) The management and distribution of resuscitative fluids in the TO, including blood
and blood products, are functions of health service logistics. In the mature theater, blood management
is based on resupply of needs from the CONUS donor base. In a developing theater during the buildup
period, immediate blood requirements may be provided by pre-positioned frozen blood. These pre-
positioned stocks are designed to meet initial blood requirements until the logistical system can deliver
liquid blood to the TO.
(2) Blood and blood products enter the theater through the USAF Blood Transshipment
Centers for further distribution to the Army blood bank platoons located in the MEDLOG battalion
(forward or rear). The CSH is supplied with blood and blood products by a blood bank platoon assigned
to the MEDLOG battalion (forward).
(3) Blood shipped into the AO will be packed RBCs only. Frozen plasma and platelets are
also available. Subject to availability, RBCs shipped from CONUS are packed with the following unit
group and type distribution:
Blood Group/Type Distribution
O Rh Positive 40%
O Rh Negative 10%
A Rh Positive 35%
A Rh Negative 5%
B Rh Positive 8%
B Rh Negative 2%
(4) Blood planning factors.
Blood Component Planning Factor
RBCs *4 units for each wounded in action (WIA) and each nonbattle
injury (NBI) casualty initially admitted to a hospital
Frozen Plasma 0.08 units for each hospitalized WIA or NBI
Frozen Platelet 0.04 units for each hospital WIA or NBI
* For blood planning purposes, only count the WIA or NBI once in the system, not
each time the patient is seen or admitted.
(5) The expected admission rates per day are critical in computing initial blood
requirements. These rates, along with the above blood planning factors, provide the planner with an
initial estimate of daily blood requirements.
Sample Calculations for Initial Blood Requirements.
Expected Initial Admission Rate for WIA and NBI = 8 per 1,000 per day
Total Personnel = 10,000
RBC Planning Factor= 4 units
(Total Personnel/1,000) X Admission Rate Per Day X Factor = Blood or
Blood Component Per Day
Example: (10,000/1,000) X 8 X 4 = 320 units of RBCs per day
(6) It is estimated that the CSH will require 113 units of blood per day. It has the
capability to store 160 units. It stores RBCs of various groups and types. The CSH has emergency blood
collection capability but does not have the capability to perform serological testing of the donor units (for
example, hepatitis, human immunodeficiency virus, and syphilis testing). Blood collection in the theater
is governed by theater policy, but normally is done to provide platelets for emergency situations. Limited
testing of blood drawn in the theater is done to minimize danger to recipients.
1. Estimated Combat Support Hospital Oxygen Planning Factors and Requirements.
(1) Estimated planning factors.
OR Table: 2.8 liter/min during operational time.
ICU Beds: 4.5 liter/min for 17 percent of the total ICU beds (patients on
ICU Beds: 3.1 liter/min for 17 percent of the total ICU beds (patients on nasal
Requirements: An additional factor of 10 percent is applied to the total of OR and
ICU requirements to account for oxygen requirements in other
areas of the hospital.
(2) Oxygen conversion factors.
1 gallon (gaseous oxygen) = 0.1333 cu ft
95 gallon “D” cylinder = 12.7 cu ft
1,650 gallon “H” cylinder = 220 cu ft
1 cu ft (gaseous oxygen) = 28.317 liters
95 gallon “D” cylinder = 359.63 liters
1,650 gallon “H” cylinder = 6229.74 liters
(3) Estimated oxygen requirements.
OR Table Hours (HUB) 96,768 liters/day
OR Table Hours (HUS) 193,536 liters/day
ICU Beds On Vent (HUB) 191,601 liters/day
ICU Beds On Vent (HUS) 266,112 liters/day
EMT and Other Oxygen Requirements 77,760 liters/day
Pneumatic Instruments 17,340 liters/day
TOTAL DAILY REQUIRED 843,117 liters/day
m. Class VIII Planning Factor.
(1) Class VIII composition.
FSC Item Percentage of PMD
6505 Drugs/biologicals and other official reagents 77.1
6510 Surgical dressings 6.8
6515 Medical/surgical supplies 8.0
Other FSCs X-ray film/development lab reagents, test 8.1
kits, patient care accessories
(2) Class VIII PMD planning factors (based on TAA 93 NATO scenario).
Troop Weight Planning Factor
Level Strength (lbs/day) PMD
Division 412,001 269,413 0.65
Combat Zone 668,607 978,712 1.46
Theater 834,014 1,297,156 1.55
(3) Supply requisitions.
924 per day 10,499 per month
(4) Class VIII weight and cube (Codes P, G, W, and Q and R).
Code P 29,369.59 lbs 1,013.496 cu ft
(potency period/expiration date)
Code G 1,493.14 lbs 67.15 cu ft
(between 35 to 46 degrees Fahrenheit)
Code W 0.04 lbs 0.003 cu ft
(must be frozen for preservation)
Code Q/Code R 573.11 lbs 32.111 cu ft
n. Estimated Combat Support Hospital Petroleum, Oil, and Lubricants/Fuel Consumption.
Gal/Day Weight Cube
Gasoline 661.10 4,098.87 lbs 88.588 cu ft
Diesel 1,129.06 7,937.28 lbs 151.293 cu ft
TOTAL 1,790.16 12,036.15 lbs 239.881 cu ft
Gasoline 68.88 427.05 lbs 9.229 cu ft
Diesel 254.81 1,791.31 lbs 34.144 cu ft
TOTAL 323.69 2,218.36 lbs 43.373 cu ft
(3) HUB/HUS TOTAL
Gasoline 729.98 4,525.92 lbs 97.817 cu ft
Diesel 1,383.87 9,728.59 lbs 185.437 cu ft
(4) Petroleum storage capability (based on hospital TOE):
Lin/Nomenclature Quantity Gallons
Tank fabric collapsible 3,000 gallons 1 3,000
Truck tank POL MTV W/E 1,500 gallons 1 1,500
Total Storage capability (gallons): 4,500
o. Water Planning Factors (Gallons of Water Per Day).
(1) Total patients (beds) X 17.25 gal=
Surgical cases X 13.0 gal=
Staff X 10.25 gal=
Bed patients X 22.0 gal =
Minimal care patients X 10.0 gal=
Staff X 9.4 gal=
7 gallons per individual
380 gallons per major end item
1/2 gal per vehicle (temperate)
1 gal per vehicle (hot climate)
Loss/waste factor = 10 percent of total requirement
(2) Hospital water requirement (consumptive factors).
Staff Water Requirement
Drinking 1.5 gal/man/day
Hygiene 1.7 gal/man/day
Food prep 1.75 gal/man/day
Extra showers 5.3 gal/man/day
Unit wastewater generation 7 gal/man/day
Patient Care Water Requirement
Cleanup 1.0 gal/bed/day
Heat treatment 0.2 gal/bed/day
Bed bath 5.0 gal/bed/day
Hygiene 1.7 gal/bed/day
Bed pan wash 1.5 gal/bed/day
Laboratory 0.2 gal/bed/day
Sterilizer 0.2 gal/bed/day
X-ray 0.2 gal/bed/day
Handwashing 2.0 gal/bed/day
Cleanup 1.0 gal/bed/day
Unit wastewater generation 12 gal/bed/day
Surgical Water Requirement
Scrub 8.0 gal/case/day
Instrument wash 2.0 gal/case/day
OR cleanup 3.0 gal/case/day
Unit wastewater generation 13 gal/case/day
Hospital Laundry Water Requirement
Bed patients 22.0 gal/bed/day
Ambulatory patients 10.0 gal/bed/day
Staff smocks 9.4 gal/bed/day
Unit wastewater generation 41.4 gal/bed/day
Decontamination Water Requirement
Individual 7 gal/decon
Major end item 380 gal/decon
Vehicle 450 gal/decon
Wastewater generation To be determined
(3) Water usage table for food and beverage preparation patient menu (gallons per meal
per 100 portions).
Menu Alternate Menu
B L D Total B L D Total
Day 1 52 29 32 113 45 28 35 108
Day 2 50 40 39 129 44 35 33 111
Day 3 48 34 32 114 23 29 18 71
Day 4 56 40 37 132 45 34 34 114
Day 5 49 42 35 126 48 37 34 118
Day 6 53 34 35 123 35 34 31 100
Day 7 51 35 36 122 45 38 33 117
Day 8 44 38 36 118 41 35 31 107
Day 9 51 35 36 122 44 33 37 114
Day 10 52 36 39 127 46 31 31 108
TOTAL 1225 1079
Note: Per 100 patients an additional 30 gallons of water per meal is required to
preheat insulated food and beverage containers for decentralized ward service.
(4) Water usage table for food and beverage preparation staff menu (gallons per meal per
Menu Alternate Menu
B L D Total B L D Total
Day 1 36 27 28 91 30 25 32 87
Day 2 35 39 38 112 29 33 30 91
Day 3 31 32 30 92 25 37 33 95
Day 4 42 39 35 116 30 32 31 94
Day 5 32 44 32 108 31 37 31 100
Day 6 42 31 34 107 36 31 31 98
Day 7 35 34 34 102 29 38 30 97
Day 8 25 38 35 98 24 33 29 85
Day 9 35 32 33 101 29 30 34 92
Day 10 36 33 38 108 30 28 30 88
TOTAL 1035 927
Daily water consumption (patient and staff): 12,180 gal/day.
Laundry daily water consumption (patient and staff): 11,650 gal/day.
TOTAL water consumption: 23,830 gal/day.
(5) Estimated water consumptive factors (under chemical environment, 72 hour scenario).
Drinking (1.5 gal/man/day) 905
Hygiene (1.0 gal/man/day) 604
Feeding (0.25 gal/man/day) 453
Patient Care (4 gal/patient/bed/day) 1,184
Surgical (3 gal/case/day) 72
TOTAL DAILY WATER REQUIREMENT: 3,218
(6) Water storage capability (based on hospital TOE):
Lin/Nomenclature Quantity Gallons
Drum, fabric, collapsible, 500 gal 6 3,000
Drum, fabric, collapsible, 250 gal 4 1,000
Tank assembly, fabric, collapsible, 3,000 gal 6 18,000
Trailer tank 11/2 ton 2 wheel 400 gal 2 800
TOTAL STORAGE CAPABILITY (GALS): 22,800
(1) The Surgeon General’s policy statement (theater hospital laundry support). Hospitals
operating in the CZ will have a basic organic laundry capability to meet mission needs. As a minimum,
this is the capability to process hospital linens, patient hospital clothing, and unit-owned duty personnel
work garment. Bath capability and laundry support for hospital staff may be obtained from available
(2) Basic formulas for determining laundry requirements for permanent party hospital
• Formula 1: 42 lbs (6 lbs clothing per person per day X 7 days) X 75 percent of
assigned personnel = weekly laundry requirement for patient care personnel.
• Formula 2: 6 lbs clothing per person per week X 25 percent of assigned
personnel = weekly laundry requirement for hospital support personnel.
• Weekly laundry requirement (Formula 1 + Formula 2) divided by number of
assigned personnel = average laundry requirement per person per week.
q. Showers. Minimum frequency for showering and laundering from a health maintenance
perspective is deemed to be once weekly regardless of location, season, or level of combat activity.
(Source: Office of The Surgeon General, Department of the Army, 31 January 1983.)
r. Solid Waste Factors.
(1) Solid waste calculation (estimated):
Total patients (beds) X 15 lbs = total patient solid waste
Staff X 12.5 lbs = total staff solid waste
(2) Hospital infectious waste planning factors (estimated):
3 lbs per cubic foot of infectious waste
3 lbs of infectious waste generated per bed per day
(3) Hospital infectious waste:
888 lbs per day 296 cu ft per day
s. Wastewater Planning Factors.
Wastewater calculations (estimated):
Total wastewater 21,394 gallons per day (estimated).
Assume that 80 percent of patient care and staff water requirements become wastewater,
and all laundry water requirements become wastewater.
t. Power Requirements. It is estimated that 823.1317 kilowatts of power will be required on a
The accumulation and disposal of waste of all types is a major problem on the modern battlefield. Not
only does this waste impact on military operations, but it also serves as a breeding ground for rodents
and arthropods. Further, the accumulation of waste contributes to environmental contamination.
Section I. OVERVIEW
C-1. General elements, such as treatment, research, and
Army policy is that all solid and hazardous
waste will be disposed of in an environmentally a. General Waste. This category
acceptable manner consistent with good sanitary includes all waste not specifically classified as
engineering principles and the accomplishment medical waste or hazardous waste. It includes
of unit mission. While operating OCONUS, either such items as—
in training or actual contingency operations, the
theater commander will determine the applica- • Paper and plastic products
bility of both US and host-country policies. (which are by far the most abundant solid waste
generated in a field environment).
C-2. Responsibility for Disposal of Waste • Garbage (generated by dining
a. Depending on the nature and vol- •
ume of waste created, units generating the waste Scrap material (wood, metal,
are normally responsible for its collection and and so forth).
disposal. b. Hazardous Waste. This includes
waste which is ignitable, corrosive, reactive, or
b. Certain types of waste require toxic, especially POL and some chemicals, and
special handling that may be beyond the capa- which requires special handling, transporta-
bility of the unit or facility. Units generating tion, disposal, and documentation. Supporting
larger amounts of waste, such as hospitals, may engineer and PVNTMED personnel can provide
not have the resources or equipment to properly guidance and assistance on the handling and
dispose of solid waste. In these cases, supporting disposing of hazardous waste.
engineer units should be contacted to provide
waste disposal support. c. Medical Waste. This waste, produced
in an MTF (nongeneral), contains pathogens of
sufficient quantity and virulence to result in an
C-3. Categories of Waste infectious disease in a susceptible host.
Waste can be subdivided into five distinct d. Human Waste. This waste is com-
categories: general waste (including solid waste), prised of feces and urine.
hazardous waste, medical waste, human waste,
and wastewater. Nonmedical solid waste (general e. Wastewater. This includes liquid
and hazardous waste) is generated by all military waste generated by laundry, shower, food service,
units. Medical waste is only generated by medical and routine MTF operations.
Section II. GENERAL AND HAZARDOUS WASTE
C-4. General C-6. Disposal of General and Hazardous
General and hazardous waste are produced by all
military units. Control and disposal of these types Most general waste is buried or burned by the
of waste requires planning and the development generating element. It can be transported in
of unit standing operating procedures. organic vehicles to a waste disposal point
(sanitary landfill). It is important to remember
that vehicles used to transport waste must be
C-5. Sources of General and Hazardous properly cleaned and sanitized before being used
Waste for other operations. During training exercises,
supporting engineers are responsible for the
a. The primary sources of general and construction and operation of the landfills.
hazardous waste are—
a. Putrescible waste from dining
• Routine troop support opera- facilities, while not hazardous or infectious in and
tions. of itself, can become both a serious aesthetic
problem, as well as a breeding site for disease-
• Maintenance and motor pool carrying rodents and arthropods. This class of
operations. solid waste must be removed and disposed of after
every meal. Burial of this type waste should be
• Administrative functions. at least 30 yards (or meters) from the food service
facility. Normally, one garbage pit is required
• Dining facility operations. per 100 soldiers per day (FM 21-10-1).
• Medical treatment facilities. b. Used oil and POL products are
classified as hazardous wastes. Disposal methods
b. In all of these operations or func- for this waste must comply with federal, state,
tions, a major effort must be made to reduce the local, and HN regulations. Military engineer and
amounts of waste generated and, thus, to lessen PVNTMED support elements can advise on
the burden on the disposal system. required disposal procedures.
Section III. MEDICAL WASTE
C-7. General and capable of producing infectious disease. For
a waste to be infectious, it must contain (or poten-
A component of medical waste, infectious waste tially contain) pathogens of sufficient virulence to
is defined as any waste generated by a hospital result in an infectious disease in a susceptible host.
C-8. Responsibility for Disposal of Medi- b. Microbiological Waste. This waste
cal Waste comes from cultures and stocks of infectious
agents from medical laboratory elements, such as
a. The hospital commander, assisted specimens or discarded vaccines from treatment
by his PVNTMED advisors, is responsible for areas.
implementing polices for medical waste manage-
ment to include- c. Blood and Blood Products. This
waste results from the use of all blood and blood-
• Identification. related products, including blood bags, blood
tubes, and material contaminated with blood.
d. Contaminated Sharps.
(1) This particular waste includes,
• but is not limited to, used—
• Hypodermic needles and
• Storage. syringes.
• Disposal. • Pipettes.
b. The hospital commander will nor- • Glass tubes.
mally designate a member of his staff to serve
as the Infectious Disease Control Officer. This • Scalpel blades.
officer assists the hospital commander in estab-
lishing infectious disease control procedures. (2) In addition to the physical
Infectious disease control procedures are estab- hazards of sharps, there is the potential for
lished to preclude the spread of infection within transmission of pathogenic organisms from
the hospital and to prevent the spread of in- puncture wounds. Unused sharps should be
fectious disease outside the facility. considered dangerous as the same puncture
C-9. Types of Medical Waste e. Surgical Waste. Surgical waste is
the material that has been contaminated as the
All medical waste may be subject to an infectious result of surgical procedures. Examples of this
nature. There are six types of medical waste category include—
requiring specific handling and disposal tech-
niques. • Soiled dressings.
a. Isolation Waste. This type waste is • Used sponges.
generated by patients who are isolated to protect
others from highly communicable diseases. It • Soiled surgical drapes.
includes all discarded materials contaminated
with blood, excretions, exudates, or secretions. • Contaminated drainage tubes.
• Other material discarded after cannot leak. A method of segregating infectious
completion of a procedure. waste from general waste is the use of distinctly
colored bags (red) for infectious waste, if available
f. Pathological Waste. This waste is (AR 40-5).
comprised of tissue, organs, body parts, and fluids
removed during a surgical procedure. Human • Sharps are placed in a rigid,
corpses (remains), however, are not considered clearly marked, puncture resistant container.
pathological waste and are handled by MA
C-10. Source of Medical Waste Needle/syringe clippers are no longer
The major sources of medical waste are patient
care areas, especially the emergency room or
EMT/triage areas, ORs, and ICUs. Medical wards • Blood, blood products, and
and laboratories are also medical waste gen- semisolid waste are placed in unbreakable capped
erators. The actual amount of medical waste or stoppered containers.
generated is dependent on the intensity and
nature of medical operations. • Medical waste is stored in
designated areas, either secured or under direct
C-11. Handling and Transporting Medical
Waste • Infectious waste is removed
from the point of generation and is disposed of at
a. Proper handling is the key to an least every 24 hours.
effective hospital waste program. Segregation of
infectious waste from general waste at the point b. The transportation of medical waste
of generation is a must. Procedures for handling within the hospital is in rigid, leakproof con-
medical waste are as follows: tainers, marked and used exclusively for its
transport. Vehicles used to transport medical
• Personnel who transport and waste to disposal sites should not be used to
dispose of infectious waste wear a disposable transport rations, clean laundry, or medical
mask, butyl rubber apron, and gloves. supplies. Before the vehicle is used for other
purposes, it must be thoroughly cleaned and
• Infectious waste is collected in sanitized using a 5 percent chlorine solution (48
ounces of chlorine granules in 5 gallons of water).
double-lined impervious containers with tight-
fitting lids, if available; otherwise double plastic
bags are used. The containers are clearly marked
as infectious waste. All bags, after being filled to C-12. Disposal of Medical Waste
only two-thirds capacity, are sealed by lapping
the gathered open end and binding it with tape The purpose of properly treating and disposing
or a closure device. This ensures that liquid waste of medical waste is to render it nonpathogenic
and make it inaccessible. Depending on the load placed in the chamber and the exposure
quantity and type of waste, command policies, time. There are a number of different types
and availability of disposal facilities and engi- of autoclaves; therefore, for detailed informa-
neer support, a variety of options exists. Every tion on the operation of a specific autoclave,
effort should be made to use the safest and refer to the manufacture’s instructions or TM.
most complete method of disposing of this waste.
c. Controlled Incineration. Incinera-
a. Training and Tactical Deployment. tion is the method of choice for most types
During training deployment in CONUS and of medical waste, but it must be controlled.
training/tactical deployment in many OCONUS Burning medical waste requires incinerators
locations (such as European), the HN envi- specifically designed for the various types of
ronmental regulations are such that disposal of medical waste. During OCONUS mobiliza-
medical waste via field expedient methods is tion deployment, an inclined plane incinerator
not permitted. Furthermore, the quantities (Figure C-1) is a field expedient when no other
and types of medical waste generated during option is available. For the hospital to build and
training are relatively limited due to the amount use this incinerator, there should be no imme-
of actual patient care. As such, the option of diate plans to relocate the hospital. This field
choice is to haul the medical waste, via military expedient incinerator is a controlled open air
vehicle or contract services, to fixed instal- burning method that can be used for burning
lations (preferably large fixed medical facilities) small amounts of medical waste; however,
for treatment and disposal according to command command approval must be given prior to its
policies. While this option does not provide use. Thorough consideration must be given to
the most ideal training, it may be the only all available options before deciding to implement
viable option available. The requirements for the open air burning method.
segregating and handling waste are critical and
remain an essential part of training.
b. Steam Sterilization. Some types of
medical waste, especially in small quantities, In all cases, ash from waste incinera-
can be rendered nonpathogenic by autoclave tion must be buried.
(steam sterilization). This technique or system
is particularly appropriate for small amounts
of waste generated in EMT areas and the d. Disposal by Burying. As a last
laboratory element (for example, contaminated resort, and with command approval, medical
dressings, needles, syringes, cultures, culture waste can be buried. Engineer support is
plates, pipettes, and blood tubes). To ensure required for construction of the waste disposal
complete disinfection, the steam sterilizer site. The waste must be covered immediately
must operate at a minimum of 250 degrees after disposal to ensure inaccessibility. All
Fahrenheit (121 degrees centigrade), under previous options are considered before accept-
15 to 17 pounds of pressure per square inch, for ing burial as the final option. Close coordi-
45 minutes. Two factors must be kept in mind nation with PVNTMED personnel and HN
when using the autoclave: the size of the authorities is essential.
Section IV. HUMAN WASTE
C-13. General direct contact, contamination of water supplies,
or dissemination by rodents or arthropods. It is
Human waste (feces and urine) disposal is essen- even more critical in a hospital environment
tial to prevent the spread of diseases caused by because patients are more susceptible to diseases
transmitted through fecal contact. All human • Number of personnel
waste must be disposed of in a manner consistent (staff and patients).
with command policy and good sanitary engi-
neering practices. • Duration of stay at
C-14. Responsibility for Disposal of Human • Geological and cli-
Waste matic conditions.
The hospital commander is responsible to provide (b) Supporting PVNTMED
human waste disposal facilities. This may require personnel and the hospital’s field sanitation team
the supporting engineer element to assist in the can assist the commander in determining the
construction of latrine facilities. appropriate type of latrines, their locations, and
a. Field Medical Treatment Facilities.
In some locations, construction and use of actual (c) Specific guidance on
field expedient waste facilities may be prohibited. selection criteria is provided in FMs 21-10 and
In this case, one option is to obtain engineer 21-10-1.
support. The option of choice is to establish
the hospital in an area with permanent or (2) Location. Location of hospital
semipermanent latrine facilities already con- latrines is a compromise between the requirement
structed and connected to an established sanitary for physical separation from dining facilities,
sewer system. However, this may only be possible water sources, and the like and the convenience
in areas designated as deployment sites. In many of access for staff and ambulatory patients. For
instances, it may be possible for hospitals to the CSH, multiple latrine sites are required
contract waste removal or latrine facilities due to the size of hospital layout and distances
through a HN support contract. Procedures will between patient care, administrative, and
vary depending on the command policy and local sleeping areas.
(HN) agreements, but waste will still have to
be separated into types by the unit. The use (3) Maintenance. Sanitation and
of chemical or self-contained toilets is another maintenance of the hospital’s latrine facilities
option instead of constructing field expedient are critical to prevent disease transmission.
latrines. In all types of arrangements, the Handwashing facilities must be placed at each
hospital field sanitation team and PVNTMED latrine.
personnel are responsible for monitoring the
achievement of field sanitation requirements c. Closing and Marking. Closing and
(FM 21-10-1). marking of latrines will be in accordance with
command policy and good field sanitation
b. Field Expedient Facilities. practices.
(1) Type selection.
C-15. Patient Facilities
(a) The type of field latrine
selected for a given situation depends on a variety a. Ambulatory patients will use the
of factors, such as— same latrines as the staff. The number of latrines
established will be based on both the number of The bedpan is placed on a tent peg or some
staff and the anticipated patient load. However, hanging device to air dry. The sinks within the
male and female latrines are required. Latrines hospital will not be used for bedpan or urinal
need to be close enough to the ward areas for disposal or washing. An area should be estab-
convenience of access while maintaining distances lished similar to that of a mess kit laundry line,
from dining facilities, water sources, and the like. using metal garbage cans and immersion heaters.
One can must have warm soapy water and the
b. Nonambulatory patients require the other can must have clear boiling water. These
use of bedpans and urinals. Disposal (of fecal cans must be clearly marked for use in cleaning
and urine) and sanitation of bedpans and urinals bedpans and urinals only.
for the nonambulatory patient is a major concern.
One or more of the hospital latrines should be
designated for bedpans and urinals, to include NOTE
their cleaning and sanitizing. Once the bedpans
and urinals are emptied, they are washed (using Personnel working with immersion
a brush) with the wastewater disposed of in the heaters should be aware of the safety
latrine or designated area. The bedpan is then precautions and be trained in im-
sanitized by submerging it into hot boiling water mersion heater operation and lighting.
for 30 seconds.
NOTE An alternative consideration is the use of
plastic bedpan liners. If plastic liners are used,
A hook or some device should be used they will reduce the requirement for cleaning
to prevent hand contact with the and sanitizing the bedpan. The plastic linings
boiling water. will then be managed as infectious waste.
Section V. WASTEWATER
C-16. General C-17. Requirement for Disposal
Water usage generally results in the produc- a. All wastewater and waterborne
tion of waste water which requires disposal. wastes generated in a field environment must be
Depending on the source, wastewater may collected and disposed of in a manner that—
contain suspended solids and particulate matter,
organic material, grease, dissolved salts, bio- • Protects water resources from
logical, pathological, and pathogenic organisms, contamination.
and toxic elements. Just the volume of waste-
water alone, without consideration of the various • Preserves public health while
contaminants, can cause significant operational minimizing mission impairment or adversely
problems in the field environment. impacting on the readiness of the force.
b. When operating OCONUS, units and potentially infectious organisms. In addition
may have to comply with applicable HN laws to the quantity of wastewater, an added problem
and procedures; this is determined by the is the multiplicity of sources within the hospital
theater commander. In an actual contingency that contribute to the complexity of collection.
operation, the theater commander (with input
from the command surgeon) determines the a. Field Sinks. Field sinks are a
applicability of local environmental laws in the primary source of wastewater from staff
AO. Irrespective of laws and regulations, proper handwashing, patient hygiene, instrument
disposal of wastewater is essential to protect the cleaning, and the like. This liquid waste is
health of the force by precluding contamination generated intermittently and the volume is
of water supplies and development of rodent and highly variable depending on the functional area
arthropod breeding sites. and patient work load. The sinks can operate
with the drain line placed in an empty 5-gallon
water can. This can must be periodically emptied
C-18. Responsibility for Disposal into a disposal system.
Units generating wastewater in the field are
responsible for their own wastewater collection
and disposal. Large volume wastewater gen-
erators, such as hospitals, may require engineer
support. Theater combat engineers will provide
support during OCONUS deployments or con-
tingency operations. In any case, the hospital
commander has the final responsibility for
coordinating disposal of his unit’s wastewater.
C-19. Wastewater Sources and Collection If wastewater collection cans or the DEPMEDS
wastewater collection system are not used, the
Hospitals generate a significant volume of sinks will drain to the immediate exterior of
wastewater corresponding to the volume of water the hospital shelter, resulting in an unaccept-
consumed. A conservative estimate of wastewater able pooling of wastewater throughout the
volume for planning purposes is that 80 percent hospital area.
of all water used (other than human consumption)
will end up as wastewater. The largest volumes b. Medical Treatment Facility Sources.
of wastewater are generated by support Sources of wastewater other than the sinks are
operations of the hospitals such as laundry, limited and will generate relatively small volumes
shower, and food service operations. While this of waste liquids. In most cases, this wastewater
type of wastewater is not unique to a hospital, it can be collected and discharged into a nearby
contributes to an enormous volume requiring sink. An exception may be the water used for
collection and disposal. However, wastewater facility and major equipment sanitation; for
generated from direct patient care functions is example, wastewater from washing OR tables, OR
unique to the hospitals and may be contaminated floors, litters, ambulances, and other medical
with blood, other body fluids, particulate matter, materiel.
c. Field Showers. and grease from the kitchen wastewater before
disposal. Information for the construction and
(1) While not an actual part of operation of the filter and baffle grease traps
the hospital system, quartermaster field showers is provided in FM 21-10 and FM 21-10-1. Also,
may collocate or be near the hospital to support hospital commanders may obtain technical
both patient and staff. These showers may also assistance from the supporting PVNTMED
support personnel of other units within the element.
area. The quartermaster personnel operating
field showers are responsible for wastewater
collection and disposal. In some situations, the C-20. Disposal of Wastewater
disposal of this wastewater may be in conjunction
with that of the hospital. a. In disposing of wastewater, a
number of factors should be considered. These
(2) If quartermaster support is include—
not available, hospital personnel must provide • Volume and characteristics of
their own showers (FMs 21-10 and 21-10-1). The the wastewater.
hospital is responsible for the collection and
disposal of this wastewater. • Operational considerations (for
example, duration of stay in a given location and
d. Field Laundries. The field laundry the intensity of combat operations).
is one of the largest generators of wastewater.
Field laundries may be collocated with or near • Geological conditions (for ex-
hospitals to provide support and can present ample, type of terrain and soil characteristics, or
an inordinate wastewater disposal problem. Like depth of the water table).
the showers, quartermaster personnel operating
laundries are responsible for wastewater col- • Climatic conditions.
lection and disposal. Because of the large volume
of water required for laundry operations, the • Availability of engineer support.
facility may have to be located away from a •
hospital and closer to a water source. In effect, Accessibility of established sew-
this location would reduce or remove what may age collection, treatment, and disposal systems.
be a wastewater disposal problem from the • Applicability of command envi-
immediate area of the hospital. (Preventive ronmental programs.
medicine personnel must ensure that laundry
personnel are trained in and properly imple- b. In light of the above factors, there
menting procedures for handling contaminated are a number of wastewater disposal alternatives
linens.) that a hospital commander may select. These
e. Field Kitchen. Army field kitchens
are also significant sources of wastewater. In • Connection to established sani-
addition to the volume, the greases and tary sewer system.
particulate matter in wastewater from a field
kitchen must be dealt with in a much more • Collection and holding waste-
deliberate manner. For instance, grease traps water for engineer or HN agency removal to a
must be constructed to remove food particles fixed treatment facility.
• An engineer-constructed semi- e. All AMEDD personnel are required
permanent wastewater collection and disposal to know how to construct and operate field
system. expedient waste facilities. For the hospital,
some engineer support in the form of excava-
• A unit-constructed field expe- tion equipment is almost always required. This
dient wastewater disposal system (FM 21-10-1). requirement will be due, in part, to the inordinate
volumes of wastewater generated by the hospital
c. In many OCONUS noncombat and its associated (kitchen, shower, and laundry)
operations, especially in the more developed facilities. Engineer support must be coordinated
countries, use of existing installation disposal and included in the site preparation planning.
facilities should be the method of choice. Even in
some contingency operations, preplanned siting f. Traditional field expedient methods
of hospitals can take advantage of preestablished of wastewater disposal consist of soakage pits,
connections to the existing sewer system. soakage trenches, and/or evaporation beds. The
Assistance from supporting engineers is required effectiveness of these methods depends on the
to establish the necessary connections and access geological conditions and the climate. While these
to the sewer system. However, grease traps or disposal devices, especially soakage pits, are
filters may still have to be used in some areas, generally constructed for small volumes of
such as the dining facility’s wastewater stream. wastewater, with proper design and operation
Traps and filters will be required to remove grease they can be effective for larger volumes. Because
and particulate matter that would adversely these methods result in final disposal, it is
affect the operation of the wastewater pumps. necessary to remove grease, particulate matter,
and other such organic material that could reduce
d. If use of a HN sewer is possible, but the effectiveness of the process. Guidance on
direct connection is not readily available, an designs and construction of these devices is
alternate approach is to consolidate and collect available in FMs 21-10 and 21-10-1 and from
wastewater in containers for eventual removal to supporting engineer and PVNTMED personnel.
a sewage treatment plant or a sanitary sewer
access by supporting engineers or HN agency. As g. In arctic environments, or when
these storage containers are not part of the geological or climatic conditions are to such
hospital’s TOE and the wastewater tank trucks extreme that soakage or evaporation is not
and pumping equipment are not standard engi- possible, the only alternative may be to collect
neer equipment, this option requires extensive the wastewater in containers for removal by
prior planning and coordination. Army engineer or HN operators.
Section I. INTRODUCTION
D-1. Safety Policy and Program within the hospital. He must continuously moni-
tor the safety program for effectiveness and
An effective safety program is essential to any identify new methods for accident prevention.
unit. Leaders must stress the importance of
constant vigilance to detect potential hazards and c. Supervisors. Supervisors enforce
reduce or eliminate these hazards. command safety directives and policies through
specific training programs, routine inspections of
a. Policy. The safety policy of the work areas, accident investigations, and prompt
Army is to reduce and keep to a minimum acci- evaluation and action to eliminate or minimize
dent manpower (and monetary) losses, thus pro- potential hazards identified by personnel.
viding more efficient use of resources and ad-
vancing combat effectiveness. d. Individuals. All personnel should
be made to realize that safety rules have been
b. Program. The unit safety program established for their protection. It is their respon-
should be designed to cover all operations and sibility to report all unsafe conditions/acts, acci-
take into consideration all conditions peculiar to dents, and near misses to their immediate super-
the specific operation of the unit. Implementation visor; to follow all instructions; and to properly use
of the program includes the establishment of a all personal protective equipment and safeguards.
safety organization consisting of a unit safety
officer responsible for the supervision and coordi-
nation of all unit safety activities and other per- D-3. Principles of Accident Prevention
sonnel as required to assist him (see AR 385-10).
An effective safety program depends on the
proper application of the following principles of
D-2. Responsibility for Accident Preven- accident prevention:
a. Stimulation of Interest. Emphasis
a. Commander. The hospital com- on safety must be vigorous and continuous, and
mander must establish and promote safety and it must originate with the hospital commander.
occupational health directives and policies to Group discussions, safety meetings, bulletin
protect personnel and equipment under his board notices, posters, and recognition of indi-
command. He must coordinate and integrate viduals for participation create interest in the
these directives and policies with those of higher safety program.
headquarters and other commands and Services.
The hospital commander appoints a qualified b. Applicability. Practical safety con-
individual as the hospital safety officer (see AR trols should be provided in all planning, training,
385-10). tactical operations, professional activities, and
b. Hospital Safety Officer. The hospi-
tal safety officer serves as an advisor to the com- c. Fact Finding. This refers to the
mander. He manages the safety program by assembly of information bearing upon the oc-
integrating safety into all functions conducted currence and prevention of accidents. For each
accident, the following facts should be deter- conform with those needs. Precautions for cer-
mined: tain medical/dental procedures or equipment are
(1) Who was injured, and what
was damaged. a. Accident Reporting: Basic to any
safety plan is accident reporting. A definite pro-
(2) The time and place where the cedure should be established that emphasizes
accident or injury occurred. prompt and complete reporting of all accidents or
injuries (AR 385-40). Supervisors must investi-
(3) The severity and cost of the gate all accidents and injuries, and when needed,
accident or injury. seek the assistance of the safety officer to deter-
mine the cause(s) and take corrective action to
(4) The nature of the accident or prevent their recurrence. Any accident resulting
injury. in damage to equipment should be reported
immediately. Continued operation of damaged
(5) Measures that can be insti- equipment can subsequently result in injuries to
tuted to guard against future recurrences. personnel.
d. Corrective Action Based on Facts. b. Safety Color Code Markings and
Any corrective action that is adopted should be Signs. Safety color code prescribes the use of
based on available and pertinent facts surround- color combinations that are effective in prevent-
ing the accident or injury. Near accidents also ing accidents and in improving production, visual
should be reported with all available information perception, and housekeeping. The code defines
so that hazards and unsafe procedures or condi- the application of colors for such specific purposes
tions can be eliminated. Similarly, any procedure as the uniform markings of physical hazards,
or condition which might be dangerous should be showing the location of safety equipment, identi-
reported so that remedial action can be instituted. fying fire-fighting equipment, and designating
colors to be used if local conditions warrant the
e. Safety Education and Training. use of color coding (AR 385-30).
The objective of safety education and training is
to develop the individual’s safety awareness so c. Fire Prevention.
he performs his tasks with minimal risk to him-
self and to others. (1) A hospital fire plan or a fire
standing operating procedure should be included
f. Inspections. The purpose of safety in the safety program. It should contain fire
inspections is to eliminate the cause of accidents prevention guidance and information on what to
through specific, methodical procedures. do if a fire occurs.
(2) NO SMOKING signs should be
D-4. Safety Plan posted wherever fire hazards exist, such as
oxygen administration and flammable materials
Many items that can be included in any safety storage areas. Smoking should be permitted only
plan are listed below, but the list is neither all- in designated safety areas. Fire-fighting equip-
inclusive nor restrictive. Certain conditions or ment should be available, and all personnel
geographical areas may require guidance to should be familiar with its location and operation.
This equipment should be inspected frequently to operate the burners. The burner units have a U-
determine if it is serviceable and operable. Fire shaped tank containing fuel under pressure.
drills should be conducted often enough for all When burners are used, they should be closely
personnel to be familiar with the procedures. monitored because of potential fire and safety
Guard personnel should be alert to fire hazards hazards. Burners must be used in well-ventilated
at night. Gasoline, oil, paint, and other flam- areas because of the buildup of carbon monoxide
mables should be stored in approved locations and gas.
in authorized containers. Oxygen and acetylene
tanks must be stored separately and apart from h. Vehicle Operation. Army Regula-
other flammables. tion 385-55 contains guidance on government
d. Generators. Generators in the field
produce the same potential electrical hazards i. Weapons and Ammunition. Con-
that are found with electricity at permanent in- tinual command emphasis should be directed
stallations and demand the same precautions. toward training each individual in the hospital in
Personnel working around generators or electri- the handling of weapons and ammunition. Train-
cal wiring should remove rings and watches. ing should begin when an individual joins the
Generators should be grounded and not refueled hospital. Commanders should ensure that all
while they are in operation. Generators used for personnel are briefed on the handling of weapons
patient treatment areas should be located to re- which accompany patients to the treatment facili-
duce, as much as possible, their noise in the ty. Weapons of hospital personnel should be
operative area. cleared and placed on safety until required other-
wise. Army Regulation 190-11 and FM 19-30
e. Housekeeping. Professional and ad- provide guidance on the physical security of
ministrative areas must be kept clean and orderly weapons and ammunition.
at all times. Hazards to personnel and equipment
can be eliminated or controlled by enforcing high D-5. Accident Investigation and Report-
housekeeping standards. ing
f. Heaters. When heaters are used, a. Investigations. Accident investiga-
they should be watched closely for potential tent tion is necessary for accident prevention. Investi-
fire. Spark arresters or flue guards on stove gation seeks to determine the cause of accidents
exhaust pipes and metal shields in stovepipe by finding the elements and sources from which
openings in tents should be used when heaters accidents develop. Corrective measures may then
are in operation. Fire guards are required when be instituted.
stoves are in use to monitor stoves for correct
operations and alert others of any potential fire b. Reporting. In accordance with AR
hazards. 385-40, the Army accident reporting system pro-
vides for the initial reporting of accidents at unit
g. M-2 Burners. The M-2 burner unit level. This is done to notify the higher echelon of
is a heat source used in the nutrition care division the command that a mishap has occurred; to record
and CMS. These units require safety precautions information that will identify causes and correc-
and trained operators who know what to do if tive actions, indicate trends, and provide a basis
the burners malfunction or a fire starts. The for formulating future plans; and to evaluate
commander may require a licensed operator to progress in accident prevention.
Section II. DEPLOYED MEDICAL UNIT
D-6. X-ray Protective Measures and (3) Radiation standards. For the
Standards personnel operating radiographic equipment, an
accumulated whole body dose, in reins, must not
a. General. Every possible safety pre- exceed 5 rem per year and 1.25 rem in a continu-
caution must be used when operating radio- ous 3-month period (for example, quarter).
graphic equipment. If all safety rules are strictly
adhered to, medical personnel should receive (4) Protective shielding. Fixed fa-
virtually no radiation dose and the patient’s ex- cilities use lead shielding to protect those working
posure will be minimized. in the area where X rays are taken. However,
b. Medical Personnel Protection and the potential of finding lead-lined facilities in a
Standards. deployed environment is limited. When deployed
hospitals use buildings of opportunity, the follow-
(1) Radiation monitoring. Army ing should be considered:
Regulation 40-14 prescribes monitoring practices
for Army personnel. It requires each person who • When using field x-ray
is occupationally exposed to ionizing radiation apparatus in a building of opportunity, a major
and who may receive an accumulated dose consideration is the location of a room or an
equivalent in excess of 62 rem/quarter to wear a isolated area where access can be easily con-
dosimeter. The unit’s medical supply personnel trolled. This area should have at least one, pref-
should coordinate dosimeter support through the erably two, walls common to the building ex-
U.S. Army Ionizing Radiation Dosimetry Center, terior. Adjoining rooms should be unoccupied.
ATTN: AMXTM-SR-DCR, Lexington, KY 40511-
5102, Defense Switched Network (DSN) 745-3948 • The upright chest bucky
or commercial (606) 293-3948. The dosimeter should be oriented towards the outside wall and
monitors the amount of radiation received by the away from the operator.
individual. The whole body dosimeter will be
worn below the shoulders and above the hips on • The x-ray apparatus
the outside of the clothing but under the lead should be positioned to maximize the distance
apron, if worn. The results are recorded on an from the back of the x-ray tube head to the opera-
automated dosimetry record by the U.S. Army tier. The apparatus should be positioned so that
Ionizing Dosimetry Center. The automated do- the x-ray beam will not routinely be directed
simetry record will be reviewed by the hospital toward occupied space or heavily traveled pas-
radiologist quarterly and then the record is kept sage ways.
permanently as part of the individual’s health
record. • The operator should wear
a lead apron or stand behind a lead-lined pro-
(2) Care and handling of dosim- tective barrier when the apparatus is used.
eter. When not being used, dosimeters will be
stored in a manner that avoids accidental • The unoccupied area out-
exposure. Dosimeters should be marked to side the building should be cleared of personnel
preclude personnel using each other’s dosimeters. for at least 50 feet from the x-ray head. This
exclusion area should include all potential areas sites, and exposed personnel. This is to be accom-
toward which the x-ray beam may be directed. plished by conducting sound level surveys on field
The 50-foot exclusion area fulfills the require- equipment (that is, compressors, generators,
ments of Technical Bulletin Medical (TB MED) medical and dental handpieces, field laboratory
521 for both the Siemens and the hand-held field equipment, and military vehicles). These data
x-ray units and is meant to control the continuous are used to identify individuals who will require
occupancy of this area. hearing protection fitting, medical surveillance,
and health education.
(5) Patient protection. Use all
means available to reduce the patient’s exposure c. Personnel identified in this survey
to ionizing radiation. The following practices will are entered in the hearing conservation program
help: and monitored by the medical unit for response
to noise exposure and adequacy of hearing-
• Take only those X rays protective devices by the periodic testing of hear-
that are required for diagnosis and treatment. ing levels. Audiograms are conducted annually,
as a minimum.
• Avoid improper position-
ing, improper exposure techniques, and faulty d. Hearing protectors are issued to all
film processing techniques. unit personnel. Their use will be required when
operating or in proximity to noise hazardous
• Use a lead apron or go- equipment such as (but not limited to) generators,
nadal shielding, if practical, to protect portions of compressors, field laboratory equipment, and
the patients body which are not in the direct tactical vehicles, 2½ tons and larger. Areas
x-ray beam. around this equipment should be identified by
placing NOISE HAZARDOUS AREA, HEARING
• Check the patient’s medi- PROTECTION REQUIRED signs as directed in
cal history. the hospital’s TSOP.
• Use the most sensitive
emulsion film available. D-8. Compressed Gas Cylinders
(6) X-ray processing. When work- All compressed gas cylinders should be con-
ing with the film-processing chemicals, personnel sidered full for handling purposes. They should
will use protective eyewear, gloves, and aprons. never be dropped or struck by any object. While
cylinders are being transported in vehicles, they
should be restrained to prevent them from falling.
D-7. Hearing Conservation Cylinders must be protected from dampness and
excessive temperatures. Smoking is prohibited
a. Technical Bulletin Medical 501 pro- near a cylinder. Valve protection caps must be
vides the guidance on unit hearing conservation installed on each cylinder. Oxygen should be
programs. stored in areas separated from other gases by at
least 50 feet. Oxygen should be separated from
b. Units should contact the PVNTMED acetylene by at least 100 feet. Gases used in
activity of the area medical support activity for laboratory procedures require caution in han-
identification of noise hazardous equipment, job dling. All compressed gas cylinders should be
labeled and tagged with the contents of the con- D-12. United States Army Environmental
tainer to avoid confusion of what material is in Hygiene Agency
There are PVNTMED assets located within each
division and at corps level. These units have
D-9. Flammable, Explosive, or Corrosive subject matter experts in most areas of environ-
Materials mental health, sanitation, industrial hygiene, and
occupational health. The mission of PVNTMED
These materials must be kept in approved safety is to provide guidance to unit commanders on
containers and away from any potential source of compliance with DA and federal requirements in
ignition. Acids used in laboratory procedures these areas. Additionally, the U.S. Army En-
should be stored in noncorrosive containers and vironmental Hygiene Agency (USAEHA) has the
cabinets designed to hold caustic/corrosive mission of looking out for the soldiers’ welfare
material. worldwide. The USAEHA is an excellent source
for advice and assistance in areas related to en-
vironmental quality or occupational health. Any
D-10. Special Equipment official Army safety representative (for example,
unit safety officer) can request assistance from
this organization. Potential areas for assistance
Individuals using high-speed medical/dental include, but are not limited to—
units and those working in the laboratory should
use piano cylinder or prescription safety eyewear • Technical assistance on monitoring
to prevent injuries to their eyes. the use of ionizing radiation, telephone DSN 584-
D-11. Department of Defense Federal Haz- • Hospital hazardous waste manage-
ard Communication Training Pro- ment on-site CONUS/OCONUS visits, DSN 584-
Department of Defense Instruction 6050.5 di- • Hospital safety program on-site
rected the elements of DOD to develop a training visits, CONUS/OCONUS, DSN 584-3040. The
program to meet the requirements of the Occupa- USAEHA also provides document review services
tional Safety and Health Act (OSHA) Hazard which may be of assistance in evaluating a unit
Communication Standard (29 C.F.R. 1910.1200). safety program.
The OSHA issued this standard to ensure every-
one’s right to work in a safe environment. It
requires that everyone understand the hazards D-13. Infection Control
of the materials they work with and know how to
minimize these hazards. It requires supervisors Special precautions must be taken during patient
to develop and maintain current listings of all treatment procedures to avoid the transmission
hazardous materials used at a work site and the of infections. Infection control, to include medical
specific hazards of each material. Material Safety waste disposal, is covered in Appendix C.
Data Sheets must be maintained at each work Detailed guidance on infection control will be
location, and personnel should be trained in the provided in the department’s, division’s, and
hazards of their occupation. section’s TSOP.
COMMUNICATIONS, AUTOMATION, AND
E-1. Operational Facility Rules and Equip- piece of communications equipment is assigned;
ment such as the commander, staff officer, or section or
a. The ability to communicate is es-
sential to C2 and the accomplishment of the c. The OPFAC rules are the basis for
assigned mission. To ensure effective commu- documenting command, control, communications,
nications, a system has evolved which authorizes and computer equipment in the basis of issue
specific types and numbers of radios for a unit plans (BOIPs) and TOEs. These determine the
or element. This appendix contains those op- correct type and distribution of radios, MSE,
erational facility (OPFAC) rules applicable to the position/navigation (POS/NAV) devices, and
CSH. tactical computers for each TOE. The OPFAC
rule system is an ongoing validation. These rules
b. The OPFAC rule is the tool used are subject to change. The rules discussed here
to determine where, type, and numbers of are current as of the date of this publication.
communication devices are needed. The OPFAC Tables E-1 and E-2 depict the OPFAC distribution
rule is the smallest element of a TOE to which a of equipment for the CSH.
E-2. Communications Equipment AM component. The Alpha series of the FM
SINCGARS radios have built-in capabilities for
The OPFAC rules expressly impact on four types encrypting/decrypting voice traffic. The AM
of communications equipment:
radios have secure voice capability when used
a. Radios. Frequency modulation and with the KY-99 minterm (Figure E-l). For the
AM radios comprise the family of radios discussed purposes of this manual, the discussion of
in this appendix as CNRs. When dealing with radios will be restricted to those authorized
OPFAC rules, the SINCGARS radios constitute for the CSH: the ANVRC-89A, AN/VRC-90A, and
the FM slice and the IHFR radio constitutes the the AN/GRC-193A.
(1) Single channel airborne radio configuration radio consisting of one short-range
system. The SINCGARS radios, AN/VRC-89A (approximately 8 kilometers [km]) and one
and AN/VRC-90A, operate in the 30- to 88- long-range (approximately 35 km), solid state,
megahertz (MHz) frequency range in 25-kilohertz securable transceiver mounted in a single
(kHz) steps for a total of 2,320 channels. They vehicular mount (Figure E-2). It is basically two
can operate in either a single-channel or vehicular-mounted, short-range radio sets with
frequency-hopping mode. an added power amplifier that provides one of
the radio sets with a long-range communications
(a) AN/VRC-89A. The AN/ capability. This radio is used by the HUB hospital
VRC-89A radio is a vehicular-mounted, dual operations section.
(b) AN/VRC-90A. The AN/VRC- over long distances (up to 35 km) (Figure E-3). This
90A radio is an AN/VRC-87A with a power ampli- radio is authorized for the hospital commander,
fier added for long-range capability. It is used where HUB; the triage/EMT, HUB; the hospital unit
the communications range must normally operate commander, HUS; and the triage/EMT, HUS.
(2) Improved high-frequency, am- hospital operations. It links the hospital with
plitude modulation radio. higher headquarters and the CHS operations net.
(a) The AN/GRC-193A is the (b) The KY-99 minterm is for
AM radio that is designed to provide reliable, long- employment with the AN/GRC-193A. One KY-99
range, high-frequency voice and data communi- minterm is required for each AN/GRC-193A. It is
cations for both mobile and fixed stations (Figure designed to provide half-duplex, narrow-band
E-4). This radio is used by the HUB hospital secure voice and data communications for a
operations section. This net is used to facilitate variety of military applications.
b. Mobile Subscriber Equipment. communications and voltage reference signal for
data subscribers in the MSE system. It is also
(1) Digital nonsecure voice tele- equipped with a data port that allows users of the
phone (DNVT): TA-1035/U. The DNVT TA- lightweight digital facsimile (LDF) AN/UXC-7 to
1035/U (Figure E-5) is a prime subscriber access MSE network. The DNVT is found in the
terminal that provides full-duplex digital voice HUB and the HUS.
(2) Tactical lightweight digital fac- transmission requiring 7 to 15 seconds to
simile: AN/UXC-7. The tactical LDF AN/UXC-7 transmit a full page. The AN/UXC-7 is found in
(Figure E-6) is a lightweight digital facsimile set, the HUB hospital operations section. It is used
rugged, waterproof, low power system capable of to send and receive hard-copy data for sup-
operating from standard alternating current and porting CHS at echelons above brigade.
vehicle direct current power. It enables electronic
transmission/reception of typed or handwritten c. Tactical Computers.
record traffic, view graphs, map overlays, trans-
parencies, and hand-drawn copies up to 8½ by 11 (1) Medical transportable com-
inches in black and white format (two shades of puter unit. The MEDTCU is the specific
gray). The LDF will operate over existing and computer hardware system configured to
proposed voice radios and wire circuits; full digital perform the TAMMIS software applications of
or analog data/voice capability. Its brief trans- MEDPAR, MEDREG, medical supply (MEDSUP),
mission (burst) reduces the chance of detection by MEDMNT and medical blood (MEDBLD). The
the enemy. The critical advantages are made Army Tactical Command and Control System-
possible by the LDF set’s ability to store data in Combat Health Support is also a computer
memory, and then send in a short, high-speed hardware system configured to perform the
TAMMIS software applications; it will be replaced with a full-size, hinged/detachable keyboard that
by the MEDTCU. The MEDTCU is used in the can be detached and relocated up to 24 inches
PAD, supply and service, and blood bank sections from the computer unit.
of the HUB. It is comprised of a transportable
computer unit, color monitor device, printer unit, (b) Color monitor device.
and an archive device (Figure E-7). This monitor device has four to eight color planes
and is driven by a video card installed in the host
(a) Transportable computer computer.
unit. This unit connects with the archive device
and printer unit and provides multitasking soft- (c) Printer. This unit is a rug-
ware resources for computational and graphic ged printer designed to satisfy 80-column printer
capability, word processing, and data base man- applications in an adverse environment where
agement. It operates from standard 115 or 230 size, weight, and power consumption are prime
volt alternating current (AC). The unit comes considerations. The printer unit is a portable
device. It employs solid state, dot matrix printing tape system is supported on the transportable
technology. computer unit.
(d) Archive device. The ar- (2) Tactical Army Combat Service
chive devive is a rugged ¼-inch (disk drive) Support Computer System. The TACCS is the
streaming magnetic tape cartidge system in- tactical hardware which operates the SIDPERS
tended to provide backup or archiving. The and the SPBS-R (Figure E-8, page E-10). This
capacity is limited with each cartridge system is used in the HUB supply and service
accomodating 67 megebytes. The archive device and the administrative divisions.
TRANSPORTABLE COMPUTER UNIT
Figure E-7. Medical transportable computer unit.
(3) Remote keyboard visual display battery-powered POS/NAV set that receives its
unit. This unit is a remote (COMMO terminal) signal from GPS satellites. The device provides a
monitor and keyboard designed for use with the very accurate position location capability for deter-
TACCS equipment. It provides the capability for mining and/or reporting self-location; however, it
data to be retrieved or entered by more than one is not a communications device. The GPS is
operator simultaneously. The remote keyboard authorized for selected sections of the HUB and
visual display unit is used in the HUB supply the HUS. The device is designed for individual
or vehicle use.
and service division.
e. Mobile Subscriber Radio Telephone.
d. Position Location/Navigation Device. This telephone is issued with MSE for primary
The precision lightweight global positioning use in vehicles. It is allocated to the HUB hospital
system (GPS) receiver (Figure E-9) is a hand-held, commander (see Figure E-10).
Section I. PERSONNEL CHECKLIST—MOBILIZATION
F-1. Personnel and Administration j. Conduct personal affairs briefing
according to AR 220-10.
a. Maintain individual records alpha-
betically by last name. If records are maintained k. Identify personnel shortages by
by an activity separate from the hospital, provide grade and MOS.
that activity an updated personnel roster as of
the 15th of each month to arrive not later than 1. Submit requisition for personnel
the 20th. Reserve Component hospitals use the shortages.
most current DA Form 1379.
m. Ensure that assigned personnel
b. Identify nondeployable personnel have enrolled their dependents in defense eligi-
and initiate procedures for reassignment and/or bility enrollment system (DEERS).
n. Ensure that dependent care plans
c. Identify and color code all reference are on file and adequate for service members and
publications to be taken with the hospital upon PROFIS personnel who are sole-parents, or are
deployment. married to another service member and have
d. Maintain personnel readiness fold- o. Appoint unit mail clerk.
ers and review them quarterly.
e. Ensure that hospital members’ (to P. Requisition and maintain recrea-
tional equipment and supplies.
include professional officer filler system
[PROFIS]) identification tags and Geneva Con- q. Appoint a unit safety officer and
vention cards are on hand and are in serviceable NCO.
r. Maintain in a current status the
f. Identify files to accompany the personnel data cards (PDCs) for all personnel
hospital in case of deployment, as well as those to assigned to include designated PROFIS person-
be destroyed. nel.
g. Maintain a 60-day supply of blank s. Appoint a unit records management
forms for deployment. coordinator to pick up and transport the hospi-
tal’s individual records (personnel, medical, den-
h. Maintain a deployment set of DA tal, and finance) in case of a deployment.
Form 3955 on all assigned personnel in alpha-
betical order. t. Ensure assigned personnel maintain
current MOS evaluation scores; where personnel
i. Appoint a (unit) family member’s have failed to verify their MOS, conduct training
assistance officer. in deficient tasks.
u. Establish procedures to recall per- mobilization/deploy merit operations) record the
sonnel absent from the unit in the event of in- deploying soldier’s essential health- and dental-
creased readiness conditions. care information on DA Form 8007, Individual
Medical History. The health record (DA Form
v. Obtain sufficient boxes to carry unit 3444 or DA Form 8005-series [Medical and Dental
files and personnel, dental, and medical records. Treatment Record]) folders of deploying soldiers
will not accompany them to combat areas. For
w. Maintain records (PDC files) on additional information, see AR 40-66.
(1) The preparation and use of DA
Form 8007 is applicable to deploying military
F-2. Finance personnel as well as civilian employees who may
accompany the unit.
a. Maintain a current roster of all
assigned and PROFIS personnel. (2) If the health record is not
available, DA Form 8007 will be completed based
b. Ensure that orders for purchasing on soldier interviews and any other locally avail-
officer and Class A agent are current and that able data. A health record may not be available
each individual is thoroughly briefed on his for Individual Ready Reserves, Individual Mobili-
duties. zation Augmentees, and retired personnel
because their health records may be on file at the
c. Upon mobilization, ensure that the US Army Reserve Personnel Center.
Class A agent contacts the mobilization station
finance and accounting office (FAO) and identifies (3) The CSH will maintain the DA
any immediate finance requirements. Form 8007 in an outpatient field file for reference
as needed. The field file will consist of, in part,
d. Establish contact with FAO upon DA Form 8007, and possibly, SF 600 (Health
arrival at the mobilization station to enhance Record—Chronological Record of Medical Care),
personnel processing. SF 558 (Medical Record—Emergency Care Treat-
ment), SF 603 (Health Record—Dental), or DD
e. Arrange for emergency financial Form 1380 (U.S. Field Medical Card).
assistance as required.
f. Advise personnel to adjust or initiate b. Ensure that immunizations for unit
allotments for dependents, as appropriate. personnel are current.
g. Upon mobilization and deployment c. Verify temporary physical profiles
notification, advise personnel of the amount of every three months.
cash and/or credit cards they should bring.
d. Maintain a record copy of all perma-
nent physical profiles.
e. Ensure all personnel requiring spec-
a. Ensure that the home station medi- tacles have at least two pairs, as well as optical
cal and dental treatment facilities (supporting inserts for their protective mask.
f. Ensure that each individual has a c. Obtain appropriate religious equip-
duplicate panographic dental X ray on file. ment and supplies.
g. Requisition and maintain medical
supplies based upon MTOE, mission(s), and con- F-6. Legal
a. Seek assistance from the staff judge
h. Ensure that each individual has an advocate in preparing unit for deployment.
ample supply of all personal medications and b. Ensure that personnel have access
other personal supplies. to an attorney to have a Power of Attorney pre-
i. Ensure that the correct blood type is pared and executed.
posted to individual records. c. Ensure that personnel see an attor-
ney to have a Last Will and Testament prepared
j. Request information on the medical and executed. Advise personnel of the impor-
threat in the deployment area. tance of a Will.
F-4. Discipline, Law, and Order d. Dispose of all disciplinary actions
pending against personnel; for example, take
a. Prepare plans for security of unit action or forward to higher commander for action.
equipment, weapons, and ammunition. e. Ascertain from the convening
b. Designate unit physical security of- authority which personnel will remain at the
mobilization site because of pending investiga-
ficer. tions or courts-martial.
c. Brief unit personnel on policy which
prohibits bringing privately owned firearms to f. Arrange for the release of indi-
viduals from pretrial confinement, if appropriate.
the mobilization station.
d. Conduct a shakedown inspection for g. Dispose of claims and military
contraband prior to movement to mobilization
F-7. Public Affairs
e. Dispose of privately owned vehicles
(POVs), firearms, pets, and other personal prop- a. Make provisions to recall unit per-
erty. sonnel through the use of electronic media out-
lets; that is, radio and television stations.
F-5. Religion b. Brief personnel on the nature and
background of the emergency which has required
a. Ensure that religious services are the mobilization.
c. Brief unit personnel on the history,
b. Provide necessary training for chap- geography, religion, language, and customs of the
el activity specialists. country or area of eventual military operations.
d. Make sure assigned personnel are assistance, health care, financial arrangements,
aware of required actions to take if contacted by and so forth.
members of the news media.
f. Advise personnel not to discuss sensi-
tive information outside of the unit; for example,
e. Inform personnel of actions to take movement dates, times, departure points, troop
and agencies available to support their family lists, means of transportation, special training,
members after mobilization; for example, legal special equipment, status of morale, and so forth.
Section II. OPERATIONS CHECKLIST—MOBILIZATION
F-8. Operations F-9. Security and Intelligence
a. Maintain current alert notification The S2 officer accomplishes all
rosters (both telephonic and nontelephonic); up- duties related to security and intelligence mat-
date monthly and conduct exercises periodically. ters. The commander is briefed as required.
b. Review the personnel security sta-
b. Brief key personnel on contingency tus of the unit and request, in order of priority,
plans and exercise requirements. interim security clearances to ensure the correct
personnel have proper clearance consistent with
c. Report attainment of deployability mission requirements, to include classified mate-
posture according to FORSCOM alert and deploy- rial escort responsibilities.
ment procedures and plans and policies of the
mobilization site. c. Ensure appropriate hospital person-
nel are familiar with duties and responsibilities
d. Monitor unit preparation for oversea in conjunction with movement and shipment of
movement (POM) operations and request guid- classified material, protection of movement data,
ance and assistance as required. and execution of classified moves, as applicable.
e. Provide current access roster to the d. Prepare to enforce primary Wartime
EOC and update as needed. Information Security Program.
Prepare hospital movement plans. (1) Appoint primary censors (one
f. for every 100 personnel).
g. Establish liaison and communicat- (2) Prepare requisition for censor–
ions with the EOC. ship stamp.
h. Obtain mission briefing and plans (3) Initiate censorship education
required for execution of deployment mission. program.
e. Conduct OPSEC training according m. Identify classified documents which
to AR 530-1 and local supplements. will not accompany the hospital.
f. Prepare briefing for hospital per- n. Review plans for the conduct of a
sonnel to be conducted when movement is immi- counterintelligence (CI) inspection of the hospital
nent. Include the following: area upon departure.
• Subversion and Espionage Di- o. Ensure timely transfer or destruc-
rected Against US Army and Deliberate Security tion of classified material not to accompany the
Violations (SAEDA). hospital.
• Procedures for classified moves. p. Request assistance for security
g. Ensure access rosters are current;
prepare and submit access rosters to the appro- q. Ensure all plans contain OPSEC
priate mobilization site staff and higher head- and CE security planning considerations.
quarters, if appropriate.
r. Maintain a list of map requirements
h. Expedite processing of pending secu- and prestock. Submit requirements to the appro-
rity clearance actions. priate staff section at the mobilization site.
i. Ensure all personnel, including s. Ensure signals security (SIGSEC)
fillers, are briefed on OPSEC practices. plans include—
j. Brief command and staff personnel • Nature and amount of infor-
on the nature of the threat of electronic warfare mation to be transmitted or protected.
(EW) and signal intelligence.
• Communications system capa-
k. Ensure personnel are aware of intel- bilities and limitations.
ligence acquisition tasks, responsibilities, tech-
niques, and reporting procedures. • Selection of available SIGSEC
kits and instructions for use.
1. If sealed-off staging areas are used—
• Basic load, source, and manner
• Conduct mission briefings at of resupply for key cards, authentication codes,
the latest possible time prior to out-loading. and other security-related codes.
• Restrict briefed personnel to • Operating procedures to
sealed-off area. include electronic counter-counter measures
(ECCM) techniques and any special require-
• Establish and enforce control- ments.
led pass procedures.
• Emergency destruction of
• Monitor and control telephone classified operating instructions and associated
t. Identify all intelligence require- b. Conduct training in air and rail
ments and submit to the appropriate security movement.
staff at the mobilization site.
c. Conduct MOS training as required.
u. Identify all linguist-qualified per-
sonnel and potential translator needs based upon
mission(s) and contingency plans. d. Conduct preventive medicine re-
fresher training (FM 21- 11). Training should
v. Review plans for the conduct of a include—
classified move according to AR 380-55 and AR
220-10. • Endemic and epidemic diseases
prevalent in the AO.
w. If deployment is from a civilian port,
make a request for port security to Intelligence
and Security Command (INSCOM) through the • Poisonous plant, wild animals,
appropriate staff at the mobilization site or home and reptiles (land and water).
• Pest management.
x. Coordinate with the appropriate
staff for any unique unit requirements. e. Conduct weapons qualification and
f. Conduct training for potential civic
a. Train field sanitation teams (FM 21- action programs which include medical opera-
10-1). tions (FM 8-42).
Section III. LOGISTICS CHECKLIST—MOBILIZATION
F-11. Subsistence • Coordinate with the appropri-
ate staff section to close accounts and turnin
a. Complete basic load of Class I (DA or transfer dining facility supplies and equip-
Form 3161) and forward to troop issue sub- ment.
b. Complete ration requirements for • Coordinate for subsistence sup-
air deployment: 3-days subsistence for pre- port of hospital personnel during the period be-
positioning of materiel configured to unit sets tween the closure of the hospital’s dining facility
(POMCUS) hospitals and 5 days for non- and hospital deployment.
e. For CSHs currently subsisting in
c. Identify rations required for person- another organization’s dining facility—
nel to accompany sea-deploying equipment.
d. For hospitals operating their own • Coordinate with the support-
dining facility— ing dining facility manager to withdraw hospital
food service personnel during deployment prep- (3) Ensure hospital draft loading
arations. plan makes provisions for carrying the 15-day
supply of expendable to accompany troops (TAT)
• Prepare plans to collect and baggage.
turn in meal cards to the supporting facility prior
to unit deployment. d. Medical sets, kits, and outfits and
• Prepare a roster of all deploy-
able and nondeployable personnel receiving basic (1) Have all sets, kits, and outfits
allowance for subsistence; for example, separate on hand or on order, follow up with status card or
rations. For deployable personnel, establish a upgrade the priority.
termination date for the basic allowance for sub-
sistence and coordinate with the supporting (2) Prepare shortage annexes for
dining facility and the finance officer. all sets, kits, and outfits on hand.
f. Ensure ration requirements for (3) Document all shortages by
patient feeding in the AO have been planned for shortage annex, report of survey, statement of
and are available. Planning for a basic load of charges, or cash collection voucher.
unique patient-feeding items may be needed until
the TO can support these items. (4) Place all shortages on requisi-
F-12. Supplies and Equipment (5) Ensure all supply catalogs are
on hand and current.
a. Ensure assigned personnel have all e. Identify all station property and
required individual clothing. Cover shortages by coordinate to ensure turn in during deployment
requisition, cash collection voucher, or scheduled preparation.
f. Ensure supply personnel are famil-
b. Ensure personnel have all required iar with procedures to close out SSSC and other
organizational clothing and equipment and items accounts.
are marked as required. Cover shortages by
requisition, cash collection vouchers, or individ-
ual purchases. F-13. Petroleum, Oils, and Lubricants
c. Expendable supplies. a. Determine requirements for pack-
aged products for deployment. Ensure necessary
(1) Prepare a list of expendable items are on hand, requisitioned, or readily avail-
supplies required for 15-day usage. able through the SSSC.
(2) Ensure all expendable supplies b. Bulk POL.
required are on hand, requisitioned, or readily
available through the self-service supply center (1) Have required 5-gallon fuel
(SSSC). cans on hand or on requisition.
(2) Have bulk POL containers ser- F-16. Medical Supplies and Equipment
viceable, or initiate appropriate repair or replace-
ment action. a. Have all required medical supplies
and equipment items on hand, or requisitioned
(3) Coordinate with the appro- through the supporting Class VIII organization.
priate staff element for the purging of bulk con-
tainers prior to deployment. Have replacement b. Have requisitions for shortages
filters on hand or on requisition for this equip- validated and obtain latest status.
c. Address the effect of shortages to the
appropriate headquarters and in unit readiness
F-14. Ammunition report.
a. Compute unit basic load and have d. Ensure that enough refrigerated
computations verified by the appropriate staff and heated storage is available for the
element at the mobilization site/home station. temperature-controlled items for shipment.
b. Prepare and submit DA Form 581 e. Ensure that medical supplies (such
for basic load. as cylinders containing oxygen and anesthesia
gases, Code R items, and other hazardous mate-
rials) requiring special handling are identified
c. If appropriate, include that portion and on hand or on requisition.
of the basic load in hospital TAT load plans.
d. Identify requirements for guard F-17. Prescribed Load List
ammunition for equipment and classified mate-
rial escorts. a. Review hospital’s PLL on all equip-
F-15. Major End Items b. Provide PLL to the appropriate sup-
a. Ensure all TOE/MTOE-required
items are on hand or on requisition. c. Have all PLL items on hand or on
b. Have all excesses identified and
turned in prior to deployment. d. Include PLL in hospital loading
c. Have all requisitions for shortages
screened for status, proper unit movement data, e. Include blocking, bracing, packing,
and priority. crating, and tie-down (BBPCT) necessary to
protect PLL in the hospital’s BBPCT forecast.
d. Identify impact of shortages to the
appropriate headquarters and in unit readiness f. Adjust PLL to reflect continuous
report. equipment operations.
g. Provide list of PLL shortages having F-20. Transportation
or anticipated to have an impact on unit
readiness to the appropriate staff element or a. Keep the hospital’s automated unit
higher headquarters. equipment list and computerized movement and
status system reports current.
F-18. Maintenance b. Train hospital personnel in the
a. Initiate equipment records for all
newly received items in accordance with DA (1) How to load unit equipment on
Pamphlet (Pam) 738-750. aircraft, trucks, and railcars for deployment,
including hazardous materials certification.
b. Identify all excess equipment and
coordinate with the support activity for turn in. (2) Preparation of packing lists.
c. Have all items requiring DS- or GS- (3) Marking of containers.
level maintenance, to include equipment to be
purged, job-ordered to the appropriate support Preparation of the transporta-
activity. tion control and movement document (TCMD)
d. Ensure calibration of equipment is (DD Form 1384).
completed, or scheduled for completion.
(5) Preparation of personnel mani-
e. Upgrade job order priorities to fests as required by the Air Mobility Command
reflect anticipated deployment dates. (AMC).
f. Notify the EOC or higher head- (6) Use of BBPCT material.
quarters of any conflict or shortfalls be-
tween estimated completion date of equipment (7) Determining center of gravity
repairs versus the required-to-load date for and marking vehicle and cargo loads.
(8) Loading vehicles for air and/or
g. Request maintenance assistance in sea deployment as appropriate.
conducting final inspection of major equipment
prior to movement and loading. (9) Preparation of movement docu-
ments for items requiring special handling and
packing and hazardous materials certification.
c. Review with the Installation Trans-
a. Review procedures necessary to portation Officer, Port Support Activity, or
close out laundry account; prepare and submit Arrival/Departure Airfield Control Group the
paperwork as necessary. support requirements for the following areas:
b. Notify laundry manager of antici- (1) Preparing, packing, and mark-
pated deployment date. ing loads.
(2) Augmenting vehicle require- b. Establish procedures to terminate
ments to support movement to POE and other all signature cards and authorizations on de-
transportation requirements. parture of the last hospital element.
(3) Providing MHE support to c. Personal property.
assist in loading.
(1) Dispose of all civilian clothing
(4) Load team and driver team re- and personal property.
(2) Have on hand or on order suffi-
cient C-boxes and inventory forms for packing
(5) Application of LOGMARS and storing of personal items which cannot be
labels. disposed of by the individual.
(6) Operation of marshaling area (3) Train supply personnel in
at POE. inventorying, packing, marking, and transferring
d. Prepare hospital movement plans to
include the following: d. Provide personnel with a list of per-
sonal comfort items that should be obtained and
(1) Convoy or move to POE. a list of prohibited items based upon projected
deployment locations, local customs and religion,
(2) Logistical support of hospital and PVNTMED guidance.
elements at POE.
e. Establish a list of personnel support
(3) Guard personnel and equip- items to be obtained based upon projected deploy-
ment at POE. ment locations such as lip balm, bug repellant,
sunscreen, and mosquito netting.
(4) Handling of hazardous and
special cargo and preparation of necessary certi-
ficates. F-22. Engineer
a. Blocking, Bracing, Packing, Crat-
. (5) Preparation of equipment and ing, and Tie-Down.
items which use or store combustibles; that is,
generators, water heaters, and so forth for ship- (1) Compute hospital BBPCT re-
ment. quirements for both air and sea deployment.
Have requirements validated by the transporta-
tion support activity and place a job order for
F-21. Miscellaneous Logistics BBPCT.
a. Establish guidance and plans for the (2) Analyze supplemental packing
establishment of a rear detachment, to include and crating requirements and, if required, submit
transfer of property and signature cards (DA appropriate request to the USAF for those
Form 1687). requirements which cannot be met. This request
should be for fabrication of supplemental packing (2) Prepare a listing of personnel
and crating for— who will have their basic allowance for quarters
(BAQ) terminated upon deployment.
• Air deployment.
c. Real Property Facilities.
• Rail deployment.
(1) Maintain a current roster of
• Surface (sea) deployment. real property facilities (RPF) managers for all
RPF assigned to the hospital.
(3) Maintain supplemental pack- (2) Identify interim RPF managers
ing and crating items. who will not deploy and will assume account-
ability for assigned RPF.
(1) Advise personnel who reside in F-23. Contracting
bachelor officers’ quarters (BOQ), bachelor
enlisted quarters (BEQ) and off-post housing of Notify the contracting activity of the anticipated
necessary termination and clearance procedures termination date of any supply or service support
on notification of deployment. provided by civilian contractors.
Section IV. PERSONNEL CHECKLIST—DEPLOYMENT
F-24. Personnel and Administration f. Following final POR, receipt for
medical and dental records. Pack them in boxes
a. Upon notification of deployment, to accompany the hospital. Personnel records will
recall all personnel, including those on leave, remain at the installation for 90 days pending
special duty, and temporary duty (except MOS- determination of where to ship them. Dental
producing schools). records (necessary for identification of remains)
will not be transported on the same vessel or
b. Submit personnel status report. airplane as service members.
c. Conduct final preparation of replace-
ments for oversea movement (POR) qualification. g. Ensure that a set of DA Form 3955
accompanies the hospital for filing at the postal
Identify nondeployable personnel and initiate activity in the AO.
procedures for reassignment and/or separation.
d. Have unit records management h. If not initiated, submit DA Form 17
coordinator assist the officer in charge at the POR for publications and blank forms.
i. Pack files, publications, and blank
e. Clear nondeployable personnel from forms which will accompany the hospital. Retire
the hospital after final POR. Return their records or destroy remaining files. Turn in excess
and update the personnel roster. publications and blank forms.
j. Carry copies of the movement orders emergency medical support while en route and at
with the hospital. the POEs.
k. Carry a copy of the current enlisted b. Identify medical personnel to
promotion list with the hospital. provide EMT during convoy and stationary
operations. Ensure that enough air bags, litters,
1. Ensure that personnel are cleared of and other equipment are set aside for their
post activities; follow-up on discrepancies. support.
m. Conduct safety orientation for all c. Identify evacuation and medical
unit personnel regarding the deployment treatment support (usually on an area basis) for
operation. each stage of deployment and movement.
n. Orient personnel on the Status of
Forces Agreement in the AO. F-26. Discipline, Law, and Order
o. Conduct personal affairs briefing in a. Have service members’ POVs placed
accordance with AR 220-10. in temporary storage or ensure that other
suitable arrangements have been made for dis-
p. Close unit Morale Support Fund posal or upkeep. For POVs temporarily stored on
account and dispose of fund property. the installation, have service member provide
Power of Attorney authorization to a responsible
q. Arrange for emergency financial individual to pick up the vehicle, or have the
assistance of hospital personnel, as needed, with service member arrange for long-term commerc-
Army Emergency Relief and Red Cross, or other ial storage at his own expense.
b. Report assigned personnel who are
r. Inform the installation postal officer, absent without leave.
in writing, of the day and time of the last postal
pick up; provide the postal officer a copy of the c. Prepare for disposition of privately
movement orders. owned weapons stored in the unit arms room.
s. Initiate action to terminate separate d. Dispose of weapons, pets, and other
rations as of the day the hospital departs the personal property.
t. Turn in recreational services
clothing and equipment except for items Ensure that religious services are available to all
accompanying the hospital. personnel.
F-25. Medical F-28. Legal
a. Ensure convoy and serial command- a. Have hospital personnel provide
ers know the sources and methods of obtaining their dependents with a Power of Attorney which
permits acceptance and termination of govern- b. Brief hospital personnel on such
ment quarters. topics as Standard of Conduct, Code of Conduct,
Hague and Geneva Conventions, and the Law of
b. Dispose of claims and military Land Warfare.
c. Apprise personnel of any operational
changes to the hospital’s mission.
c. Orient personnel on Status of Forces
Agreement. d. Brief personnel on their eventual
d. Advise personnel on importance of a
Power of Attorney and having a Will. e. Use the hometown news release pro-
gram, if warranted.
f. Continue coordination with installa-
F-29. Public Affairs tion.
a. Keep hospital personnel appraised g. Continue command information pro-
of the current overall emergency situation re- gram throughout the period of mobilization and
quiring the mobilization and deployment. deployment.
Section V. OPERATIONS CHECKLIST—DEPLOYMENT
F-30. Operations F-31. Security and Intelligence
a. Conduct overseas orientation in a. Review the personnel security
accordance with AR 220-10. status to ensure sufficient numbers of personnel
are properly cleared consistent with mission
b. Report attainment of deployability requirements to include classified material escort
posture in accordance with FORSCOM emer- responsibilities.
gency action procedures and installation EOC
policies and procedures. b. Ensure appropriate personnel are
familiar with the duties and responsibilities in
c. Monitor hospital POM operations, conjunction with classified movement and
and provide guidance and assistance, as required. shipment, if applicable.
d. Prepare appropriate plans and Initiate censorship education
e. Coordinate hospital movement.
d. Conduct OPSEC program.
f. With the approval of the hospital
commander, appoint an officer or NCO as rear e. Prepare briefing for unit personnel
detachment commander. to be conducted when movement is imminent.
Briefing will include, but not be limited to, the • Establish and enforce control-
following: led pass procedures.
(1) Dissemination of movement • Monitor and control telephone
data on a need-to-know basis. use.
(2) Procedure for handling move- • Ensure personnel hospitalized
ment documents. or confined during staging are isolated until pub-
lic announcement of the operation.
(3) Procedures for handling classi- • Collect letters and other per-
fied material in transit. sonal mail and place in sealed mail bags until
public announcement of the operation.
(4) Subversion and Espionage
Directed Against US Army and Deliberate Secu- i. Identify classified documents which
rity Violations. will not accompany the hospital.
(5) Procedures for classified j. Ensure timely transfer or destruc-
moves. tion of classified material not to accompany the
f. Ensure all personnel, including
fillers, are briefed on OPSEC practices. k. Review plans for the conduct of a CI
inspection of the area upon departure.
g. Brief command and staff personnel
on the nature of the threat’s EW/signals intelli- 1. Review plans for the return of cryp-
gence capabilities. tographic material, not accompanying the hos-
pital, to the office of record or issue; transfer as
h. If sealed-off staging areas are used— appropriate.
• m. Ensure all plans contain OPSEC,
Establish strict security. communications, and electronic security planning
• Enforce blackout camouflage.
n. Plan for the distribution of maps and
• Conduct mission briefing at related topographical materials.
the latest possible time prior to out-loading.
If deploying from a civilian port,
• Restrict briefed personnel to forward request for port security to INSCOM
sealed-off area. through appropriate channels.
Section VI. LOGISTICS CHECKLIST—DEPLOYMENT
F-32. Subsistence F-33. Supplies
a. Draw unit basic load of rations and a. Pack the hospital’s 15-day supply of
store with TAT cargo. expendable with TAT cargo.
b. Draw rations to support deployment b. Report significant shortfalls in
(3 days for POMCUS units, 5 days for non- expendable supplies to the supporting element.
POMCUS units) and load in a readily accessible
manner. c. Report shortfalls in individual
clothing items to the supporting element.
c. Arrange subsistence support to any
portion of the unit that will not accompany the d. Report shortfalls in organizational
main body. clothing and equipment to the supporting
d. For hospitals operating their own
dining facility— e. Report shortfalls in tools and/or test
equipment to the supporting element.
• Close out all accounts and
hand receipts. f. Close out all station property
• Turn in or transfer all unused
rations and condiments.
g. Close out SSSC account, and
• complete credit and turn in.
Make arrangements to subsist
assigned personnel at another activity from the
closure of the dining facility until deployment. F-34. Ammunition
e. For hospitals supported at another
activity’s dining facility— a. Draw basic load of ammunition;
include in the TAT cargo load plans.
• Make arrangements with the
supporting facility for final turn in of meal cards. b. Draw necessary ammunition to
guard equipment during deployment.
• Coordinate with supporting
dining facility for the release of deploying food
service personnel. F-35. Major End Items
f. Submit the necessary paperwork to a. Turn in all excess items and other
the finance office to terminate basic allowance for equipment not accompanying the hospital.
subsistence for any personnel receiving it; ar-
range to subsist personnel on the termination of b. Pick up all incoming items of
their basic allowance for subsistence. equipment on the property records.
c. Report shortages to the EOC and the e. Have unit mechanics available to
supporting element. support convoy moves to the POE. Arrange for
F-36. Medical Items f. Arrange for recovery support, both
internal and external, and address in the move-
a. Ensure all medical items and ment plans.
supplies are received and included in the loading
plans. g. Maintain floats for those that cannot
be taken out of support maintenance.
b. Report shortages to the EOC and the
c. Ensure that all medical supplies re-
quiring special handling (paragraph F-16) are on Transportation planning and requirements repre-
hand and included in the loading plans. sent the most detailed and transient elements of
the deployment process. As a result, a complete
checklist of all possible requirements would be
F-37. Repair Parts too bulky for meaningful use by the commander.
Therefore, the commander and the unit move-
ment coordinator must be thoroughly familiar
a. Adjust PLL to reflect any equipment with FORSCOM and installation mobilization
increases and expected increased utilization; requirements. Presented below are major topics
have PLL at 100 percent fill; if not, report critical that are common to the various modes of deploy-
shortage to the supporting element. ment.
b. Prepare loading plans which place a. General.
the PLL in a readily available location.
(1) Configure unit vehicle loads for
air and/or sea deployment, as appropriate.
(2) Mark all vehicles, crates, and
a. Complete calibration. pallets as required.
b. Close out DS and GS job orders at (3) Have all vehicles clean and free
the maintenance support facility. from leaks and seeps.
c. Conduct inspection of vehicles and (4) Have fuel pods and bladders
other major end items to ensure that they are prepared and certified.
ready for deployment. Take corrective action as
required. (5) Have all required BBPCT on
hand and properly used.
d. Complete equipment records for
newly received equipment according to DA Pam (6) Mark all TAT cargo with 3-inch
738-750. red or yellow disk and stencil “TAT” on the disk.
(7) Prepare packing lists (DD (3) Submit request to AMC for per-
Form 1750). sonnel being air transported.
(8) Designate armed guards for (4) Prepare DD Form 1387-2 for
classified and sensitive cargo. hazardous cargo to be airlifted.
b. Convoy Operations. (5) Prepare DD Form 2940-R for
vehicles, trailers, military-owned demountable
(1) Submit road clearances (DD containers, pallet loads, or other exterior shipping
Form 1265) and oversized cargo clearance (DD containers.
Form 1266) to the supporting transportation
element for unit moves to POE. (6) Prepare aircraft load plans as
required by Military Airlift Command.
(2) For movement to seaport POE—
• Provide convoy and serial F-40. Miscellaneous Logistics
commanders with strip maps, EMT and emer-
gency maintenance instructions, and other points a. Finalize support arrangements for
of contact. rear detachment, if required.
• Coordinate and finalize b. Have all supply and maintenance
billeting and messing arrangements for drivers. accounts closed out and signature cards canceled.
• Ensure priority for unit c. Notify the appropriate activity, in
writing, of the termination date of any contract
recovery capability is given to POE convoy. that provides supplies or services.
(3) Allocate maintenance person- d. Secure personal property.
nel to each convoy to assist in final preparation of
vehicles for loading. (1) Inventory and pack personal
(4) Brief each serial commander
on refueling and defueling requirements. (2) Provide service members with
a copy of the personal property inventory.
(5) Arrange, as required, for civil-
ian or military escort. (3) Transfer all personal property
to the supporting transportation element.
(1) Have TCMDs (DD Form 1384) F-41. Engineer
completed; one form for each vehicle or other
exterior container. a. Blocking, Bracing, Packing, Crat-
ing, and Tie-Down.
(2) Have load plans completed for
each vehicle; load plans will reflect necessary last (1) Determine, in coordination
minute adjustments. with the appropriate office, specific BBPCT
requirements for deployment based on actual (7) Provide sufficient trained
personnel and equipment for movement; actual teams to execute rail, air, and sea loading opera-
method of movement; equipment for movement; tions. Type team is dependent upon specified
and POE. method of deployment.
(2) Request any necessary BBPCT b. Billeting.
support from the USAF. The request should
identify— (1) All personnel in BOQ or BEQ
will clear quarters.
• The location of the POE
at which the support is required. (2) Notify finance of the cutoff date
for BAQ (quarters allowance) for all single per-
• The date and time which sonnel.
hospital personnel will report to the POE, and (3) Brief dependent families on
the date and time they will depart (deploy). family quarters policies and procedures.
(3) Request any packing and (4) All personnel residing off-post
crating support necessary to supplement organic will either terminate their leases or make other
assets for sealing previously fabricated supple- suitable arrangements.
mental packing items.
c. Real Property Facilities.
(4) Provide space in the unit area
for packing and crating operations. (1) Request termination of assign-
(5) Deliver equipment and
supplies to the designated packing and crating (2) Request designation of interim
base of operations. RPF manager through command channels.
(6) Maintain a packing list for (3) Transfer accountability for RPF
each box packed. to the interim RPF manager prior to deployment.
THE GENEVA CONVENTIONS
G-1. Law of Land Warfare G-2. Medical Implications of Geneva Con-
a. Sources of the Law of Land Warfare.
a. Provisions for Collection of Wounded
(1) The Law of Land Warfare is and Sick. Provisions must be made for the
drawn from two sources: collection and treatment of wounded and sick
personnel, whether friend or foe, military or
(a) The first is treaty law. civilian, regardless of legal status. Only urgent
Treaties are formally enacted under procedures medical reasons will determine priority in the
set out in the US Constitution. They are laws of order of treatment to be administered. This
the highest order and statutes and regulations means that wounded enemy soldiers may be
must comply with them. They govern all US treated before wounded Americans or allies. For
soldiers and civilians. enemy personnel wounded as a result of military
operations, dual responsibilities must be carried
(b) The second source of Law out—custodial and medical. The custodial
of Land Warfare is customary international law. activity of guarding the wounded EPW should be
Once a practice is internationally accepted, carried out by assets other than AMEDD
either by widespread treaty enactment or other personnel. The echelon commander will des-
agreement, it becomes customary international ignate nonmedical units to act as guards when
law. Once this occurs, it regulates even countries EPW are in medical channels.
which do not agree with the concept concerned.
b. Accountability and Custody of
(2) In the area of CHS, the prin- Enemy Prisoners of War (Geneva Convention
cipal treaties are the Geneva Convention for the Relative to the Treatment of Prisoners of War,
Amelioration of the Condition of the Wounded and 12 August 1949). Enemy prisoners of war
Sick in Armed Forces in the Field (12 August evacuated through medical channels must be
1949) and the Hague Resolutions. These are identified and their accountability y established
found in DA Pam 27-1. For the commander, FM prior to evacuation per appropriate TSOP. Sick,
27-10 is a handbook reference which will provide injured, and wounded prisoners may be evacu-
the answers to questions concerning the law of ated through normal medical channels, but they
war. are segregated from US and allied personnel.
They may also be evacuated through dedicated
b. Geneva Convention for the Amelio- or task-organized evacuation assets, particularly
ration of the Condition of the Wounded and in rear areas where they are likely to be moved
Sick in Armed Forces. The GWS provides for in a group.
protection of armed forces members and other
persons who are wounded and sick on the c. Responsibility for and Handling of
battlefield. It provides for members of the conflict Prisoners of War. The US Army is responsible
to take all possible measures to search for and for the care and treatment of EPW from the
collect the wounded and sick; to protect them moment of capture. Below brigade level, these
against pillage and ill treatment; to ensure their prisoners are handled by combat troops who bring
adequate care; and to search for the dead and them to the forward or brigade collecting points.
prevent their being despoiled. It further provides Enemy prisoner of war patients will be evacuated
for the protections afforded AMEDD personnel. from the CZ as soon as possible. Only those sick
or wounded prisoners who would run a greater prisoners of war. United States medical personnel
health risk by being immediately evacuated may or medical units that are captured would do
be temporarily kept in the CZ. When intelligence likewise, continuing to provide medical support
sources indicate that large numbers of enemy behind enemy lines. In such a situation, this
prisoners may result from an operation, medical would probably be a primary source of treatment
units may require reinforcement to support the for US prisoners of war, although enemy wounded
additional EPW patient work load. In this case, could be treated also.
the care of the EPW wounded becomes a joint
matter between the ground combat commander (4) Enemy civilian medical per-
and the medical commander. Procedures for sonnel who are physicians, surgeons, dentists,
estimating the medical work load involved in nurses, or medical orderlies may also be required
the treatment and care of enemy prisoners are to use their medical knowledge in the interest of
described in FM 8-55. For a more detailed prisoners of war. These medical personnel are
discussion on the administration, handling, considered protected (under the Conventions)
treatment, and identification of EPW, see AR and receive the same treatment as retained
190-8, FM 8-10, and FM 19-40. military medical personnel.
d. Identification and Protection of (5) Personnel protected as medical
Medical Personnel. personnel under the GWS must be exclusively
engaged in medical duties or administration of
(1) Personnel exclusively engaged medical units. This includes all members of a
in the performance of medical duties in con- medical unit, even cooks, mechanics, drivers,
nection with the sick or wounded in medical units or administration personnel. However, this
or establishments shall wear, affixed to the left protection is given only if the soldier is exclusively
arm, a water-resistant brassard/arm band engaged in medical duties. Performance of any
bearing the distinctive emblem (the red cross on nonmedical duty removes the protection, and the
a white background) prescribed by the Geneva DD Form 1934 must be withdrawn. For example,
Conventions. The wearing of brassards/arm if an ambulance driver is tasked with driving
bands will be at the discretion of the tactical an unmarked vehicle forward with ammunition
commander in far forward areas. prior to evacuating casualties rearward, he would
not be exclusively engaged in medical duties
(2) Medical personnel are to carry and could not be considered or credentialed as
a special identity card, DD Form 1934 (Geneva “medical personnel.”
Conventions Identity Card for Medical and
Religious Personnel Who Serve in or Accompany e. SelfDefense (GWS).
the Armed Forces), issued to all persons
qualifying as protected medical personnel (see (1) Medical personnel may carry
AR 640-3). It will be carried in addition to their arms for defense of themselves and their patients.
regular identification card. This does not mean that they may resist capture
or fire on the advancing enemy. It means that, if
(3) Enemy military medical per- the enemy is attacking and ignoring the marked
sonnel who are captured are considered retained medical status of the medic or the medical unit,
personnel and not prisoners of war. They will the medic may provide self-protection. Of course,
receive the benefits and protection of the Geneva it is preferable and proper to attempt to avoid
Conventions and may be required to treat capture by withdrawal.
(2) The arms that medics may use shall be hoisted only over such medical units and
are only defensive arms. By Army regulation facilities (except veterinary) as are entitled to
these are defined as service rifles (M-16s) and be respected under the Conventions and only
pistols. Other US services restrict arms to pistols with the consent of the tactical commander of a
alone. brigade-size or larger unit. The marking of
facilities and the use of camouflage are
(3) The GWS does not itself incompatible and should not be attempted
prohibit the use of Article 24 personnel in concurrently. Use of the red cross is authorized.
perimeter defense of nonmedical units such as The camouflage of medical units is regulated by
unit trains logistics areas or base clusters under Army regulations and also, in the European
overall security defense plans, but the policy of theater, by NATO STANAG 2931. It is not
the US Army is that Article 24 personnel will not envisioned that fixed, large medical facilities
be used for this purpose. Adherence to this policy would be camouflaged. The commander must
should avoid any issues regarding their status be aware of who has the authority to order
under the GWS due to a temporary change in camouflage and for what period it may last. The
their role from noncombatant to combatant. camouflage of medical facilities is one of the
Medical personnel may guard their own unit more difficult ones to reconcile with operational
without any concurrent loss of their protected necessities. The problem has been present in past
status. wars but is now more critical due to the ability of
intelligence assets to see deep into the rear AO.
(4) If medical personnel fire on If the failure to camouflage endangers or com-
enemy troops or otherwise abuse their protected promises the tactical operations, the camouflage
status, they may lose their special status under of medical facilities may be ordered by a NATO
the Law of Land Warfare. It is also possible that commander of at least brigade level or equivalent.
such a violation could result in a war crimes trial Such an order is to be temporary and local in
by the capturing force. For instance, if an enemy nature and is countermanded as soon as circum-
force was advancing on a marked medical facility stances permit.
but was not firing on it and medical personnel
then took advantage of the situation and fired on (b) The camouflage of a
the enemy, this would be an offense. Under the medical unit does not deprive it of protection.
Law of Land Warfare, this action would constitute However, the enemy is not required to respect a
an act of perfidy or treason. It would be akin to camouflaged facility until he recognizes it as such,
firing on soldiers exposed under a flag of truce. so the protection is illusory to a point, especially
where indirect fire weapons are involved. The
use of defensive arms by medical personnel at a
camouflaged site attacked by ground maneuver
forces poses a dilemma. The medics should
attempt to make the attackers aware of their
f. Marking of Medical Units/Facilities status rather than fighting back. However, that
and Ambulances. may be difficult to do on the modern battlefield.
(1) Medical units and facilities. (c) If medical facilities are
used to commit acts harmful to the enemy, the
(a) The distinctive flag (red protection of those facilities may be withdrawn if
cross on a white background) of the Conventions the acts are not stopped after warning. This
might be the case where a facility is used as an h. Captured Medical Supplies and
observation post or if combat information was Equipment. Because medical supplies and equip-
reported or relayed through the facility. ment captured from the enemy are considered
neutral and protected, they are not to be
(2) Ambulances. intentionally destroyed. If these items are
considered unfit for use, or if they are not needed
(a) Air and ground ambu- for US and allied forces, noncombatants, or EPW
lances will be marked with the distinctive red patients, they may be abandoned for enemy use.
cross emblem. There is no legal reason why the Since captured medical personnel are familiar
ambulances could not have the red cross removed with their medical supplies and equipment, the
and then be used for nonmedical roles. It should captured items are especially valuable in the
be remembered that the aviators and drivers may treatment of EPW. Use of these captured items
not do nonmedical tasks without losing their for EPW and the indigenous population helps to
medical status. As such, the policy that benefits conserve other medical supplies and equipment.
the mission to the greatest degree is to use When the capture of US medical supplies and
ambulances exclusively for medical tasks. equipment by enemy forces is imminent, these
items are not to be purposely destroyed. Every
attempt must be made to evacuate them. Those
(b) The US policy is that items which cannot be evacuated should be
crew-served weapons may not be mounted on abandoned; however, such abandonment is a
armored ambulances or air ambulances, even if command decision.
mounting brackets are present.
(c) Vehicles other than am- G-3. Compliance with the Geneva Con-
bulances may be used in a dual role, moving ventions
wounded to the rear under removable red crosses.
However, the red crosses must be removed before a. As the US is a signatory to the
nonmedical tasks are attempted, and care must Geneva Conventions, all medical personnel
be taken so that the protection provided by the should thoroughly understand the provisions
red cross is not abused. that apply to CHS activities. Violation of these
Conventions can result in the loss of the pro-
tection afforded by them. Medical personnel
g. Civilians—Wounded and Sick should inform the tactical commander of the
(Geneva Convention Relative to the Protection of consequences of violating the provisions of these
Civilian Persons in Time of War, 12 August 1949). Conventions.
Civilians who are wounded or become sick as a
result of military operations will be collected and b. Outright violations of the Geneva
provided initial medical treatment in accordance Conventions result when—
with theater policies and transferred to appro-
priate civil authorities as soon as possible. All • Medical personnel are used
those wounded and sick as a result of an armed to man any offensive-type weapons or weapons
conflict will be collected and cared for. The eche- systems.
lon commander and medical unit commanders
jointly exercise responsibilities for custody and • Medical personnel are ordered
treatment of the sick, injured, or wounded and to engage enemy forces other than in self-defense
detained civilian personnel. or in the defense of patients and MTFs.
• Crew-served weapons are other than medical priority, urgency, or severity
mounted on a medical vehicle. of wounds.
• Mines or booby traps are placed • Allowing the interrogation of
in and around medical units and facilities. enemy wounded or sick even though medically
• Hand grenades, light antitank • Allowing anyone to kill, tor-
weapons, grenade launchers, or any weapons ture, mistreat, or in any way harm a wounded or
other than rifles and pistols are issued to a sick enemy soldier.
medical unit or its personnel.
• Marking nonmedical unit
• The site of a medical unit is facilities and vehicles with the distinctive emblem
used as an observation post, a fuel dump, or an or making any other unlawful use of this emblem.
ammunition storage site.
• Using medical vehicles marked
c. Possible consequences of violations with the distinctive Geneva emblem for trans-
described in b above are— porting nonmedical troops, equipment, and
• Loss of protected status for the
medical unit and personnel. • Using a medical vehicle as a
• Medical facilities attacked and
destroyed by the enemy. e. Possible consequences of violations
described in d above are—
• Medical personnel being con- • Criminal prosecution for war
sidered prisoners of war rather than retained crimes.
persons when captured.
• Reprisals taken against our
• Combat health support capa- wounded in the hands of the enemy.
bilities are decremented.
• Medical facilities attacked and
d. Other examples of violations of the destroyed by the enemy.
Geneva Conventions include—
• Medical personnel being con-
• Making medical treatment sidered prisoners of war rather than retained
decisions for the wounded and sick on any basis persons when captured.
COMBAT SUPPORT HOSPITAL LAYOUT
A sample of a hospital layout without a chemical and biological protected shelter system is
shown in Figure H-1. The patient decontamination area shown is applicable for the hospital with or
without collective protection. The patient decontamination area should be at least 30 to 50 yards
downwind of the hospital. The actual layout of the hospital is contingent upon the METT-T factors and
guidance provided by the hospital commander.
A sample layout for a hospital (HUB) with a chemical and biological protected shelter system is
shown in Figure H-2.
SAMPLE OPERATIONS ORDER WITH ANNEXES
SOURCES USED FM 55-9. Unit Air Movement Planning. 5 April
These are the sources quoted or paraphrased in FM 55-65. Strategic Deployment by Surface
this publication. Transportation. 10 May 1989.
FM 55-312. Military Convoy Operations in
Continental United States. 3 April 1991.
2068 Med. Emergency War Surgery (Edition 4)
(Amendment 3). October 1991. DOCUMENTS NEEDED
2931. Orders for the Camouflage of the Red Cross
and Red Crescent on Land in Tactical These documents must be available to the
Operations. 18 October 1984. (Latest intended users of this publication.
Amendment, 11 June 1991.)
Joint and Multiservice Publications
Joint and Multiservice Publications
FM 3-5. NBC Decontamination. FMFM 11-20.
DOD instruction 6050.5. Hazard Communica- 23 July 1992.
tions Program. 29 October 1990. FM 8-285. Treatment of Chemical Agent
29 Code of Federal Regulation (1910. 1200). Casualties and Conventional Military
Hazard Communications. 1 July 1993. Chemical Injuries. AFM 160-12; NAVMED
FM 55-12. Movement of Units in Air Force Air- P-5041. 28 February 1990.
craft. AFM 76-6; FMFM 4-6; OPNAVINST
4630.27A. 10 November 1989. (Change 1,
28 December 1992.)
FM 100-20. Military Operations in Low Intensity Army Publications
Conflict. AFP 3-20. 5 December 1990.
SB 10-495. Standard “B” Ration for the Armed AR 40-5. Preventive Medicine. 15 October 1990.
Forces. NAVSUPINST 10110.6A; MCO AR 40-14. Control and Recording Procedures
P10110.25C. 29 November 1984. for Exposure to Ionizing Radiation and
Radioactive Materials. Defense Logis-
tics Agency Regulation (DLAR 1000.28).
Army Publications 15 March 1982.
AR 40-66. Medical Records Administration.
AR 30-1. The Army Food Service Program. 1 June 1992.
1 January 1985. (Reprinted with basic AR 190-8. Enemy Prisoners of War—Admin-
including Changes 1—6, 15 May 1992.) istration, Employment, and Compensation.
FM 8-21. Health Service Support in a Com- 1 June 1982. (Reprinted with basic
munications Zone. 1 November 1984. including Change 1, 1 December 1985.)
FM 10-23. Basic Doctrine for Army Field AR 190-11. Physical Security of Arms, Ammu-
Feeding. 2 December 1991. nition, and Explosives. 31 March 1986.
FM 55-1. Army Transportation Services in a *AR 220-10. Preparation for Oversea Movement
Theater of Operations. 30 November 1984. of Units (POM). 15 June 1973.
* This source was also used to develop this publication.
AR 380-55. Safeguarding Classified Defense *FM 8-55. Planning for Health Service Support.
Information in Movement of Persons and 9 September 1994.
Things. 28 May1971. *FM 8-505. Army Medical Field Feeding
*AR 385-10. Army Safety Program. 23 May 1988. Operations. 10 November 1989.
AR 385-30. Safety Color Code Marking and *FM 11-30. MSE Communications in the Corps/
Signs. 15 September 1983. Division. 27 February 1991.
AR 385-40. Accident Reporting and Records. FM 19-30. Physical Security. 1 March 1979.
1 April 1987. FM 19-40. Enemy Prisoners of War,
AR 385-55. Prevention of Motor Vehicle Civilian Internees, and Detained Persons.
Accidents. 12 March 1987. 27 February 1976.
*AR 530-1. Operations Security (OPSEC). 1 May *FM 21-10. Field Hygiene and Sanitation.
1991. 22 November 1988.
*AR 570-2. Manpower Requirements Criteria. *FM 21-10-1. Unit Field Sanitation Team.
15 May 1992. 11 October 1989.
*AR 611-101. Commissioned officer Classifi- FM 21-11. First Aid for Soldiers. 28 October
cation System. 30 April 1992. 1988. (Change 2, 4 December 1991.)
*AR 611-201. Enlisted Career Management *FM 27-10. The Law of Land Warfare. 18 July
Fields and Military Occupational Special- 1956. (Reprinted with basic including
ties. 30 April 1992. Change 1, 15 July 1976.)
AR 630-5. Leave and Passes. 1 July 1984. * FM 55-30. Army Motor Transport Units and
(Reprinted with basic including Changes Operations. 14 March 1980. (Reprinted
1—11, 16 March 1988.) with basic including Changes 1—3, 19
AR 640-3. Identification Cards, Tags, and October 1989.)
Badges. 17 August 1984. (Change 1, 18 FM 100-5. Operations. 14 June 1993.
November 1991.) FM 101-5. Staff Organization and Operations.
AR 700-23. Supply of Health and Comfort Items. 25 May 1984.
1 November 1981. *FM 101-10-l/l. Staff Officers Field Manual—
AR 700-138. Army Logistics Readiness and
Sustainability. 16 June 1993. Organizational, Technical, and Logistical
*DA Pam 27-1. Treaties Governing Land War- Data (Volume 1). 7 October 1987.
fare. 7 December 1956. *FM 101-10-l/2. Staff 0fficers Field Manual—
DA Pam 738-750. Functional Users Manual for Organizational, Technical, and Logis-
The Army Maintenance Management tical Data Planning Factors (Volume 2).
System (TAMMS). 27 September 1991. 7 October 1987. (Reprinted with basic
*FM 8-10. Health Service Support in a Theater including Change 1, 17 July 1990.)
of Operations. 1 March 1991. *TC 8-13. Deployable Medical Systems—Tactics,
*FM 8-10-6. Medical Evacuation in a Theater of Techniques, and Procedures. 7 December
Operations—Tactics, Techniques, and Pro- 1990.
cedures. 31 October 1991. TB MED 521. Management and Control of
*FM 8-10-7. Health Service Support in a Nuclear, Diagnostic X-Ray, Therapeutic X-Ray, and
Biological, and Chemical Environment. Gamma-Beam Equipment. 15 June 1981.
22 April 1993. TM 8-500, Volume I. Nutritional Support
*FM 8-42. Medical Operations in Low Intensity Handbook. 1 October 1982. (Change 1,
Conflict. 4 December 1990. February 1990.)
TM 8-500, Volume II. Nutritional Support DD Form 1384. Transportation Control and
Handbook. 15 October 1989. (Change 1, Movement Document. April 1966.
April 1993.) DD Form 1387-2. Special Handling Data
Certification. June 1986.
Department of the Army Forms DD Form 1750. Packing List. September 1970.
DD Form 1934. Geneva Convention Identity Card
DA Form 17. Requisition for Publications and for Medical and Religious Personnel Who
Blank Forms. October 1979. This form Serve In or Accompany the Armed Forces.
is for local use only. Do not use for July 1974.
requisitions to US Army Publications.
DA Form 581. Request for Issue and Turn-in of
Ammunition. August 1989. Standard Forms
DA Form 1155. Witness Statement on Individual.
June 1966. SF 558. Emergency Care Treatment. June 1982.
DA Form 1156. Casualty Feeder Report. June SF 600. Health Record—Chronological Record of
1966. Medical Care. May 1984.
DA Form 1379. US Army Reserve Components SF 603. Health Record—Dental. October 1975.
Unit Record of Reserve Training.
DA Form 1687. Notice of Delegation ofAuthority- READINGS RECOMMENDED
Receipt for Supplies. January 1982.
DA Form 2940-R. Unit Loading Inventory and These readings contain relevant supplemental
Checklist (Work Sheet). December 75. information.
DA Form 3161. Request for Issue and Turn-in.
DA Form 3444. Terminal Digit File for Treatment Joint and Multiservice Publications
Record (Orange). January 1979.
DA Form 3955. Change of Address and Directory AR 27-50. Status of Forces Policies, Procedures,
Card. February 1979. and Information. SECNAVIST 5820.4G.
DA Form 5913-R. Strength and Feeder Report 15 December 1989.
(LRA). June 1990. AR 40-350. Patient Regulating To and Within
DA Form 8005. Outpatient Medical Record the Continental United States.
(OMR) (Orange). November 1991. BUMEDINST 6320.ID; AFR 168-11; BMS
DA Form 8007. Individual Medical History. CIR 75-15; CGCOMDTINST 6320.8A. 30
November 1991. March 1990.
AR 40-535. Worldwide Aeromedical Evacuation.
AFR 164-5; OPNAVINST 4630.9C; MCO
Department of Defense Forms P4630.9A. 1 December 1975. (Reprinted
with basic including Change 1, 10 May
DA Form 1265. Request for Convoy Clearance. 1979.)
January 1959. AR 40-538. Property Management During Patient
DA Form 1266. Request for Special Hauling Evacuation. BUMEDINST 6700.2B; AFR
Permit. January 1959. 167-5. 1 June 1980.
DA Form 1380. US Field Medical Card. June AR 40-562. Immunizations and Chemo-
1962. prophylaxis. NAVMEDCOMINST 6230.3;
AFR 161-13; CGCOMDTINST M6230.4D. AR 40-35. Preventive Dentistry. 26 March 1989.
7 October 1988. AR 40-46. Control of Health Hazards from Lasers
FM 3-3. Chemical and Biological Contamination and Other High Intensity Optical Sources.
Avoidance. FMFM 11-17. 16 November 6 February 1974. (Reprinted with basic
1992. including Change 1, 15 November 1978. )
FM 3-100. NBC Defense, Chemical Warfare, AR 40-61. Medical Logistics Policies and
Smoke, and Flame Operations. FMFM Procedures. 30 April 1986. (Change 1,
11-2. 23 May 1991. August 1989.)
FM 8-8. Medical Support in Joint Operations. AR 40-400. Patient Administration. 1 October
NAVMED P-5047; AFM 160-20. 1 June 1983.
1982. (Reprinted with basic including AR 71-13. The Department of the Army Equip-
Change 1, May 1975.) ment Authorization and Usage Program.
FM 8-9. NATO Handbook on the Medical Aspect 3 June 1988. (Change 1, 1 June 1993.)
of NBC Defensive Operations. NAVMED AR 310-25. Dictionary of United States Army
P5059; AFP 161-3. 31 August 1973. Terms (Short Title: AD). 15 October 1983.
(Reprinted with basic including Change 1, (Reprinted with basic including Change 1,
May 1983.) May 1986.)
FM 8-33. Control of Communicable Diseases AR 380-40. Policy for Safeguarding and
in Man. 15th Edition. NAVMED P-5038. Controlling Communications Security
31 May 1991. (COMSEC) Material (U). 22 October 1990.
FM 10-63. Handling of Deceased Personnel in a AR 750-1. Army Materiel Maintenance Policy and
Theater of Operations. AFM 143-3; FMFM Retail Maintenance Operations. 27
4-8. 28 February 1986. September 1991.
FM 41-5. Joint Manual for Civil Affairs. DA Pam 710-2-1. Using Unit Supply System
OPNAV 09B2P1; AFM 110-7; NAVMC (Manual Procedures). 1 January 1982.
2500. 18 November 1966. (Reprinted with basic including Changes
FM 90-3. Desert Operations. FMFM 7-27. 1—12, 1 January 1992.)
24 August 1993. DA Pam 710-2-2. Supply Support Activity Supply
TB MED 507. Occupational and Environmental System: Manual Procedures. 1 March
Health Prevention, Treatment, and Control 1984. (Reprinted with basic including
of Heat Injury. NAVMED P-5052-5; AFP Changes 1—10, 31 January 1992.)
160-1. 25 July 1980. FM 8-10-8. Medical Intelligence in a Theater of
Operations. 7 July 1989.
FM 8-50. Prevention and Medical Management
Army Publications of Laser Injuries. 8 August 1990.
FM 8-230. Medical Specialist. 24 August 1984.
AR 40-2. Army Medical Treatment Facilities: FM 19-1. Military Police Support for the AirLand
General Administration. 3 March 1978. Battle. 23 May 1988.
(Reprinted with basic including Changes FM 19-4. Military Police Battlefield Circulation
1—2, 15 March 1983.) Control, Area Security, and Enemy
AR 40-3. Medical, Dental, and Veterinary Care. Prisoner of War Operation. 7 May 1993.
15 February 1985. (Change 1, 30 July FM 22-9. Soldiers Performance in Continuous
1993.) Operations. 12 December 1991.
AR 40-4. Army Medical Department Facilities/ FM 26-2. Management of Stress in Army
Activities. 1 January 1980. Operations. 29 August 1986.
FM 31-70. Basic Cold Weather Manual. 12 April FM 700-80. Logistics. 15 August 1985. (Change
1968. (Reprinted with basic including 1, 30 March 1990.)
Change 1, December 1968.) SB 8-75 Series. Army Medical Department
FM 34-3. Intelligence Analysis. 15 March Supply Information. (Expires 1 year from
1990. date of issue.)
FM 41-10. Civil Affairs Operations. 11 January TB Med 1. Storage, Preservation, Packing,
1993. Maintenance, and Surveillance of Materiel:
FM 90-6. Mountain Operations. 30 June Medical Activities. 15 June 1981.
1980. TB MED 501. Occupational and Environmental
FM 90-10 (HTF). Military Operations on Health: Hearing Conservation. 15 March
Urbanized Terrain (MOUT) (How to Fight). 1980. (Reprinted with basic including
15 August 1979. Change 1, 31 October 1980.)
FM 100-9. Reconstitution. 13 January 1992. TM 38-750-1. The Army Maintenance
FM 100-15. Corps Operations. 13 September Management System (TAMMS) Field
1989. Command Procedures. 29 December 1978.
FM 101-5-1. Operational Terms and Symbols. (Reprinted with basic including Changes
21 October 1985. 1—2, February 1984.)